
Class „ l_ 

Book l 

CopyiightN 

COPYRIGHT DEPOSIT. 



3 



NOTES 



ON 



MATERIA MEDICA 



BY 

ROBERT F. WILLIAMS, M. A., M. D., 

PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS IN THE MEDICAL 
COLLEGE OF VIRGINIA. 

a 









RICHMOND, VA.: 

Whittet & Shepperson, Publishers and Printers. 

1902. 



THE LIBRARY OF 

CONGRESS, 
Two Coptt* Recsiveo 

OCT, 2 1902 




C' ass COXXc No. 

corv 8. 



Copyrighted 

by 

ROBERT F. WILLIAMS, M. D. 

1902. 



PREFACE. 

This book is throughout entirely selective in character, 
and aims in no degree at completeness. It is not intended 
to replace the regular text-book, but has been written as 
an aid to the student in the study of the text-book. 

Much confusion arises in the minds of students from 
the enumeration of many different theories in regard to 
disputed points, and I have, therefore, in this book made 
categorical statements concerning such doubtful matters, 
choosing the explanation which seemed to me most 
rational, with the view of simplifying for them an intricate 
subject. 

Parenthetical references throughout the description of 
the different drugs refer, under the titles "Antagonists" 
and "Synergists," to other drugs having like or contrary 
action, for comparison with the one under consideration. 

Under the heading "Therapeutics" numerical references 
show the action of the drug for which it is indicated in 
the given disease. 

The latter part of the book contains a list of the prepara- 
tions of the drugs herein described in most common use, 
at least in this part of the country. 

In the preparation of these notes, I have made free use 
of works on the subject by Butler, Cushny, Wood, Hare, 
Wilcox, Ringer, Thornton, and others. 

R. F. W. 
508 East Grace St., Richmond, Va., 
September, 1902. 



CONTENTS. 

Page. 

How Drugs Act, 7 

Drugs Acting Systemically : 

Stimulants of the Nervous System, 9 

Stimulants of the Circulatory System, 21 

Stimulants of the Respiratory System, 33 

Depressants of the Nervous System, 38 

Hypnotics, 42 

Analgesics, 51 

Motor Depressants, 54 

Anesthetics, 57 

Depressants of the Circulatory System, 63 

Depressants of the Respiratory System, 68 

Restoratives, - 70 

Alteratives, 76 

Antiperrodics, 88 

Drugs Having Localized Action : 

Bitters, 92 

Digestants, 93 

Emetics, 94 

Anti-Emetics, ! 101 

Cathartics, 102 

Simple Purgatives, -. 103 

Hydragogue Purgatives, 104 

Salines, 105 

Drastic Purgatives, 106 

Administration of Cathartics in General, 107 

Anthelmintics, 108 

Hematics no 



6 CONTENTS. 

Drugs Having Localized Action — Continued. Page. 

Expectorants, 113 

Diuretics, 119 

Diaphoretics, 121 

Emmenagogues and Oxytocics, 123 

Uterine Depressants, 124 

Vesicants and Pustulants, 125 

Rubefacients, 125 

Caustics, 127 

Astringents, 127 

Antiseptics, 135 

Organo-Therapy, 143 

Serum-Therapy, 146 

List of Preparations and Index, 149 



HOW DRUGS ACT. 

A small number of drugs act physically, e. g., oils as 
protective dressings ; salts in changing osmotic values of 
fluids. 

Most drugs act by chemical affinity for certain forms of 
living matter, probably forming temporary combinations 
with some forms of protoplasm, and altering the function 
of all cells which contain these forms. This alteration of 
function is only of degree, the character of the function 
remaining the same. 

Drugs may act in three ways — stimulation, depression 
or irritation. Stimulation is the increase of the specialized 
functional activity of a cell. Depression is the decrease of 
the specialized functional activity of a cell. Irritation 
produces physical alteration of a cell. The less highly 
specialized cells are more subject to irritation, which may 
be explained by their known reactions, e. g., substances 
which dissolve or precipitate proteids, or withdraw fluids ; 
the more highly specialized cells are more subject to 
stimulation. 

Excessive or prolonged stimulation will cause depres- 
sion of protoplasm. This depression resembles the fatigue 
produced by the continued normal function of the cell. 
This may go on to paralysis, in which condition the cell 
is functionally dead, but after elimination the function is 
restored. Excessive irritation causes actual death and 
disintegration of the cell, from which there is no recovery. 

Most drugs have an elective affinity for certain definite 
tissues. That this is not a difference in degree is shown 
by the fact that some drugs will act in an opposed manner 
on different parts of the body. 



8 HOW DRUGS ACT. 

The primary action is that due to the unaltered drug; 
the secondary action is that due to compounds formed 
with the drug while in the body. The local action of a 
drug is that produced by its direct contact with an organ. 
This may be immediate, i. e., before entering the circula- 
tion, or remote, i. e., in the act of elimination from the 
circulation. Systemic action is that produced while the 
drug is being conveyed by the blood to the various tissues 
and centers. Reflex action is that produced at a distant 
part through the influence of nervous connections. 

In certain instances a marked relationship has been 
observed between the chemical constitution and the physio- 
logical action of drugs. In chemical combinations some- 
times the base and sometimes the acid seems to determine 
the action. 



DRUGS ACTING SYSTEMICALLY 



STIMULANTS OF THE NERVOUS SYSTEM. 

VOLATILE OILS. 

This group of drugs includes a large number of 
preparations which depend chiefly, if not entirely, on 
the volatile oil contained. Though they will be divided 
later into several smaller groups according to their 
special action, they all possess certain action in com- 
mon as follows : 

1. External Action. Antiseptics, due to their vola- 
tility enabling them to penetrate protoplasm readily. 
They differ in germicidal power, and affect moulds 
more than bacteria. Confined on the skin, they are 
irritants, causing redness, tingling, warmth (local 
hyperemia). 

2. Internal Action. — Digestive Tract. In the mouth 
they are antiseptic and irritant to the mucous mem- 
brane. They cause reflexly a flow of saliva and gastric 
juice. Stomach, antiseptic ; irritant, causing hyper- 
emia, thereby increasing absorption ; they increase 
the muscular activity of the stomach, and stimulate 
reflexly the flow of gastric juice. Intestines, as in the 
stomach, they act as antiseptics, stimulants to peris- 
talsis, and produce hyperemia, increasing absorption. 
Carminatives. 

3. Systematic Action. Absorbed into the blood, 
they stimulate the various nerve centres, and increase 
mildly circulation and respiration. 



10 NOTES ON MATERIA MEDICA. 

4. Absorption and Elimination. They are quickly 
absorbed, and are eliminated by the bronchial mucous 
membrane, kidneys and skin, stimulating the functional 
activity of these parts and exerting their antiseptic 
action. These effects are produced by direct stimula- 
tion of the glandular cells, by increasing the blood 
supply locally, and by stimulation of the nerves sup- 
plying the glands. 

Poisoning. Symptoms of gastric, intestinal and 
renal irritation ; vomiting, purging, acute abdominal 
pain, blood in stools and vomited matter, collapse, 
weak pulse and respiration, anuria or albumin and 
blood in the urine, coma and death. 

Classification. These drugs are classified as follows : 

Class I. Acting on or used chiefly for stimulation 
of the heart and central nervous system. 

Class II. Acting on or used chiefly for stimulation 
of digestive tract. 

Class III. Acting on or used chiefly for stimulation 
of bronchial mucous membrane. 

Class IV. Acting on or used chiefly for stimulation 
of kidneys and genito-urinary tract. 

Class V. Acting on or used chiefly for stimulation 
of the skin. 

The last four classes will be considered later. 

Class I. contains the following drugs : Asafetida, 
camphor, musk, ammoniacum and valerian. These 
constitute the so-called "antispasmodics." The special 
action of this class is the stimulation of the higher 
inhibitory centers, increasing the coordinating power, 
and depression of the lower centers, diminishing mus- 
cular activity. 

Contra Indications. Acute inflammations of gastro- 
intestinal tract. 



STIMULANTS OF THE NERVOUS SYSTEM. u 

Comparison of individual characteristics. 

Asafetida is the most laxative, exerts the greatest 
influence on menstruation, gives characteristic odor 
to excretions and in poisoning causes more gastro- 
intestinal disturbance. 

Therapeutics. Atonic dyspepsia, constipation, flatu- 
lent colic (2) ; infantile convulsions, whooping-cough, 
chorea, hysteria (3). 

Camphor is the most irritant to digestive tract, most 
stimulant to general circulation, large doses (mono- 
bromated) depress respiration and generative func- 
tions, may cause headache, vertigo, dry mouth, flush- 
ing, clamminess, etc. 

Therapeutics. Erythema, urticaria, "chapped skin," 
coryza, ozena (1) ; flatulent colic, diarrhea, cholera 
(2) ; whooping-cough, chorea, melancholia, mania, de- 
lirium of fevers (3) ; dysmenorrhea, chordee, phthisi- 
cal and rheumatic sweats, eneuresis (4). 

Musk is nearly like camphor. 

Therapeutics. Hysteria, hiccough, crises of low 
fevers, adynamic pneumonia (3). 

Ammoniacum has more effect on bronchial mucous 
membrane. 

Valerian may cause in large dose formication of the 
hands and feet, and a condition approaching melan- 
cholia. Sometimes it produces hallucinations. Gives 
characteristic ordor to the urine. More effective than 
asafetida in hysteria. Both owe effects largely to their 
bad odor. 

Therapeutics. Like asafetida, menopause (vaso- 
motor disturbances), hypochondriasis, nervous head- 
ache, vertigo (anemic), diabetes (3). 



12 NOTES ON MATERIA MEDICA. 

AROMATICS. 

Amisum, cinnamomum, coriandrum, foeniculum 
(fennel), capsicum (cayenne pepper), piper (black 
pepper), myristica (nutmeg), macis (mace), caryo- 
phyllum (cloves), pimenta (allspice), cajuput, carda- 
momum, zingiber (ginger), lavandulae flores (laven- 
der), mentha piperita (peppermint), menthol, mentha 
viridis (spearmint), thymol, carum (caraway). 

The action of these drugs depends on the volatile 
oils which they contain, and is like that of the other 
volatile oils elsewhere described. [Classes II. and V.] 

Therapeutics. Flatulence, for flavoring, corrective 
to purgatives, counter irritation, gastric fermentation, 
colic, simple diarrhea. 

Contra Indications. Acute inflammatory conditions 
of the gastro-intestinal tract. 

CANNABIS INDICA. (Hashish.) 
Incompatibles — Caustic alkalies, acids, aqueous preparations. 

1. External Action. On the skin it is mildly sedative 
to sensory nerve terminals. 

Antagonists — Irritants, rubefacients, etc. Synergists — 
Cocaine, belladonna, aconite, etc. 

2. Internal Action. — Digestive Tract. Slightly seda- 
tive to the stomach, it produces no constipation. 

Antagonists — Bitters, strychnine. Synergists — Aconite, 
cocaine, bromides, etc. 

3. Circulation. Slight acceleration of the pulse and 
slight increase of arterial tension due to general nerv- 
ous stimulation. 

Antagonists — Aconite, etc. Synergists — Alcohol, ether 
and other cardiac stimulants. 

4. Nervous System. Like opium, it first stimulates, 
and then depresses the brain. Stimulation lasts longer, 



STIMULANTS OF THE NERVOUS SYSTEM. 13 

but sleep is not so profound, and is disturbed by 
dreams and illusions. Analgesic, but feebler than 
opium. It causes some tingling and numbness fol- 
lowed by cutaneous anesthesia. 

Antagonists — Strychnine, etc. Synergists — iUcohol, ether, 
bromides, opium, cocaine, narcotic drugs. 

5. Respiration. No marked action. General nervous 
stimulation may quicken slightly. 

6. Eye. Pupil dilated and vision exaggerated. 

7. Uterus. Stimulates uterine contractions, but can- 
not inaugurate them. 

8. Elimination. Slow, often twenty-four to thirty- 
six hours, avenue unknown. The urine is increased, 
but other secretions are not affected. 

Poisoning. Happy delirium ; loss of sense of time ; 
double consciousness as if the hemispheres were acting 
independently ; loss of sense of space ; reasoning 
power retained ; sometimes oppression and anxiety ; 
desire to kill ; increased sexual desire, but not power. 
Depression follows ; lessened motor power ; dullness ; 
lassitude ; headache ; vertigo ; insanity. 

Treatment. Stomach pump ; strychnine ; faradism ; 
lemon juice ; caustic alkalies incompatible. 

Administration. Preparations vary greatly in 
strength, therefore begin always with minimum dose, 
and increase till effects desired are obtained. 

Therapeutics. Not much used. May be tried when 
opium is contraindicated. Melancholia, mania, neu- 
ralgia, migraine, irritable cough of phthisis and bron- 
chitis, spasm of bladder, chordee (4) ; corns (1) ; 
subinvolution, chronic metritis, dysmenorrhea, men- 
orrhagia (7). 



14 NOTES ON MATERIA MEDICA. 

COCA— COCAINE. 

Incompatibles — Caustic alkalies, alkaline carbonates and 
bicarbonates, mercury, bichloride, iodides, ammonia, borax. 

1. External Action. Absorbed by mucous mem- 
brane, but not by the unbroken skin. It paralyzes the 
sensory nerve terminals, producing local anesthesia, 
and causes vaso-motor constriction followed by dila- 
tation. Eye. Anesthetic by action on sensory nerve 
terminals. Dilates pupils by stimulation of peripheral 
ends of the sympathetic nerves, the pupil still, how- 
ever, reacting to strong light. It does not paralyze 
accommodation. 

Antagonist — Physostigma. Synergist — Atropine. 

2. Internal Action. — Digestive Tract. By local 
action in nose and mouth the senses of smell and taste 
are temporarily destroyed. In the stomach it obtunds 
the sensory nerves, causing a loss of the sense of 
hunger, but it does not act as a food. Digestion 
normal, or better than usual, after its use. Peristalsis 
stimulated by moderate doses. 

Antagonists — Irritants. Synergists — Aconite, carbolic 
acid, hydrocyanic acid. 

3. Nervous System. Stimulant to brain (intellectual 
centers), producing exhilaration, calm, peace and a 
sense of wellbeing. This is followed by mental and 
physical depression. No effect on sensory nerves by 
internal administration. Excessive dose may cause 
cerebral convulsions and paralyze sensory nerves. 
Effects on cord not understood. Stimulation of motor 
tracts gives sense of muscular power. Muscles are 
also directly stimulated. Stimulation of constrictor 
fibers of sympathetic nerve increases activity of non- 
striated muscular fibers (peristalsis, etc.). 

Antagonists — Morphine, chloral, chloroform, ether. Syn- 
ergists — Alcohol, belladonna. 



STIMULANTS OF THE NERVOUS SYSTEM. 15 

4. Circulation. The force and frequency of the heart 
are increased, and arterial tension is raised, but the 
mode of action is not understood. Excessive doses 
depress circulation. 

Antagonists — Amyl nitrite, aconite, etc. Synergists — Al- 
cohol, belladonna, strychnine, etc. 

5. Respiration. Stimulated in frequency and force. 
Large doses paralyze the respiratory center (dyspnea, 
etc., death by respiratory failure). 

Antagonists — Hydrocyanic acid, aconite, bromides, etc. 
Synergists — Belladona, strychnine, caffeine, etc. 

6. Temperature. Not affected by medicinal dose, 
large doses increase by over heat-production. 

7. Absorption and Elimination. Quickly absorbed. 
Eliminated changed by kidneys, increasing urinary 
flow — nitrogenous elements decreased. Partly oxi- 
dized in the body. No cumulative action. 

Untoward Action. Loss of speech, blindness, ver- 
tigo, nausea, convulsions, circulatory and respiratory 
disturbances, copious albuminous urine. 

Cocaine Habit. Physical symptoms, tendency to 
collapse, thready pulse, anorexia, emaciation, irregular 
and depressed respiration, dropsy, numbness, twitch- 
ings, convulsions, insomnia, visual hallucinations, 
headache, vertigo, elevated temperature, fetid breath. 
Moral and mental degeneration. 

Treatment. Amyl nitrite, caffeine, ammonia, atro- 
pine, chloroform, ether, strychnine hypodermically. 
Withdrawal of drug (suddenly or gradually). Diffi- 
culty of treatment. Prognosis. 

Administration. Internally at three to six hour in- 
tervals. Hypodermically in one to ten per cent, solu- 
tions, limit two to three grains. Infiltration method 
by injection in, not under, the skin of a 0.1 to 0.2 per 



l6 NOTES ON MATERIA MEDICA. 

cent, solution of cocaine in 0.8 per cent, solution of 
sodium chloride. 

Therapeutics. Various minor operations and dis- 
eases of eye, mouth, nose, throat, rectum, vagina, 
urethra (1). Other minor operations hypodermically. 
Gastralgia, sea-sickness, vomiting (2) ; convalescence, 
debilitated conditions (3, 4, 5). 

Contra Indications. Administer cautiously in disease 
of the kidneys, and in case of weak or diseased heart. 

CAFFEINE. 

1. External Action. It has practically no action. 

2. Internal Action. — Digestive Tract. Moderate 
doses stimulate peristalsis, slightly laxative. In the 
form of tea, however, this is counteracted by the 
astringent action of the tannin contained in large 
amount. Large doses derange digestion, causing ca- 
tarrh, indigestion, hepatic congestion, etc. 

Antagonists— Opium, belladonna, bromides. Synergists — 
Bitters, alcohol, physostigma. 

3. Nervous System. A rapidly acting stimulant of 
the brain and cord, causing increased rapidity of 
thought by stimulation of the intellectual centers, in- 
creasing power for continued mental work, differing 
from opium in that the latter stimulates the imagina- 
tive centers. Moderate doses increase reflexes (refresh- 
ing), larger doses or continued dosage excite reflexes 
(nervousness), excessive doses diminish reflexes. 
Continued use causes wakefulness, delirium, etc. 

Antagonists — Bromides, chloral, opium, trional, etc. 
Synergists — Strychnine, coca, alcohol, etc. 

4. Circulation. Stimulation, whether by action on 
nervous system or on heart muscle is unknown. Pulse 
rate is increased, the period of diastole shortened 



Stimulants of the nervous system. 17 

(digitalis), and systole lengthened. Arterial tension 
is raised independent of direct action on the vaso- 
motor centers. 

Antagonists — Aconite, nitrites. Synergists — Alcohol, dig- 
italis, ammonia, strychnine, belladonna, ergot, etc. 

5. Respiration. Stimulated by moderate dose and 
depressed by excessive dose. 

Antagonists — Hydrocyanic acid, bromides, etc. Syner- 
gists — Strychnine, belladonna, ammonia. 

6. Absorption and Elimination. It is freely ab- 
sorbed. Eliminated by the kidneys, it directly stimu- 
lates the renal cells. Blood pressure is at first lowered 
and then raised. Solids and liquids are increased. 
Tissue waste is lessened. It is partly oxidized in the 
body. 

Synergists — All diuretics. 

Poisoning. Not frequent. Semi-consciousness, de- 
lirium, slow, irregular pulse, clammy skin, anesthesia, 
reeling gait, frequent copious urination, tetanic con- 
vulsions. 

Treatment. Emetics, stimulants, external heat, etc. 

Untoward Effects. Cerebral congestion, delirium 
like alcoholism, rise of temperature, tremors, palpita- 
tion, gastralgia, emaciation. 

Administration. For hypodermic use the sodio- 
benzoate of caffeine (forty-five per cent.) is more 
desirable. 

Therapeutics. Chronic nephritis (6) ; valvular heart 
disease, fatty heart, myocarditis, cardiac depression of 
fevers (4) ; cardiac and renal dropsy, pleuritic effusion 
(4, 6) ; migraine, headache, nervous diarrhea (3) ; 
alcoholism, collapse from ether and chloroform, opium 
poisoning (3, 4, 5) ; hiccough (3). 

Contra Indications. Acute inflammations, particu- 
larly of the kidneys. 



18 NOTES ON MATERIA MEDICA. 

NUX VOMICA— STRYCHNINE. 

Incompatibles — Tannic acid, bromides, iodides, chlorides. 
The action of mix vomica and its alkaloid, strych- 
nine, is identical. The action of brucine is like 
strychnine, but feeble. 

i. External Action. Strychnine is antiseptic, but is 
dangerous to use for this purpose on account of the 
strength of solution necessary. 

2. Digestive Tract. Acts as a bitter tonic, stimulat- 
ing the flow of saliva and gastric juice. Direct stimu- 
lant to the muscular coats of the stomach and intes- 
tines. 

Antagonists — Opium, belladonna, etc. Synergists — Bit- 
ters, physostigma, capsicum, etc. 

3. Nervous System. Stimulant to the central nerv- 
ous system, especially to the motor side of the cord. 
Resistance between the sensory and motor tracts 
lessened. Stimulant to perceptive centers. Conduc- 
tivity of motor nerves increased. Reflexes increased 
by augmented susceptibility to stimuli. Stimulates 
medullary centers. Convolutions of the brain slightly 
stimulated. 

Antagonists — Chloral, bromides, chloroform, opium, phy- 
sostigma, gelsemium. Synergists — Caffeine, coca, etc. 

4. Circulation. Stimulates heart muscle, increasing 
force. Inhibitory center stimulated, but stimulation 
of cardiac ganglia prevents slowing of pulse. Arterial 
tension raised by increased force and by stimulation of 
vaso-motor center. Poisonous dose reduces circulation 
by paralysis. 

Antagonists — Aconite, nitrites, chloroform. Synergists — 
Alcohol, caffeine, digitalis, ammonia, belladonna, ergot. 

5. Respiration. Respiratory center stimulated, in- 



STIMULANTS OF THE NERVOUS SYSTEM. 19 

creasing depth and rate. Poisonous dose causes 
tetanic contraction of respiratory muscles, producing 
death by asphyxiation, and paralysis of respiratory 
center. (Heart continues to beat). 

Antagonists — Hydrocyanic acid, bromides, etc. Syner- 
gists — Belladonna, caffeine, ammonia, camphor. 

6. Temperature. Oxidation is increased by strych- 
nine, shown by the increase in urea and carbon dioxide. 
Heat production is therefore increased, but body tem- 
perature is not much increased, due to increased heat 
elimination by increased superficial circulation. Body 
temperature much raised during convulsions. 

7. Special Senses. Vision and hearing more acute. 
Uterus stimulated. 

8. Absorption and Elimination. Quickly absorbed 
and slowly eliminated, strychnine has cumulative 
action. Eliminated by the kidneys (catheterize in 
poisoning). Partly oxidized in the body. 

Untoward Action. Children very susceptible. Long 
continued may produce peevishness, delirium, etc. 
Chills in malarial patients (due to stimulation of sym- 
pathetic nervous system). Small doses may poison. 
Scarlatinous rash, red eyes, formication, heavy stiff 
limbs, persistent and painful erections, etc. 

Poisoning. Sudden or gradual development. Acute- 
ness of vision and hearing. Stiffness of back of neck. 
Facial twitchings. Tetanic (or tonic) convulsions. 
Opisthotonos (emprosthotonos). Eyes staring. 
"Risus sardonicus." Respiration interfered with. 
Convulsions, always by peripheral stimulation, may be 
caused by light, noise, touch, etc. Convulsions not 
continuous. Painful cramps. Lockjaw late. Death 
by asphyxiation due to locking of respiratory, muscles. 
Mind unaffected till poisoning by carbon dioxide. 



20 NOTES ON MATERIA MEDICA. 

Stomach retentive. Involuntary ejaculation of semen 
and incontinence of urine. In the intervals the patient 
is mentally depressed and fearful of death. 

Treatment. Emetics, tannin and stomach pump. 
Amyl nitrite, potassium bromide and chloral. By 
rectum if patient cannot swallow. Chloroform. Ca- 
theterization. Move bowels by croton oil per rectum. 
Physostigma, tobacco, alcohol, opium. 

Differential Diagnosis. Epilepsy (clonic convul- 
sions). Tetanus (lockjaw early, relaxations never 
complete, history). Hysteria (hystory). 

Administration. Usually before or between meals. 
May be given in increasing doses as tolerance is estab- 
lished. Only fresh solutions of strychnine should be 
used. Preparations of crude drug vary in strength. 
Strychnine by rectum very active. 

Therapeutics. Atonic dyspepsia (2, 3) ; alcoholic 
gastric catarrh, vomiting of pregnancy, constipation, 
atonic diarrhoea, prolapse of the rectum (2) ; pneu- 
monia, typhoid fever, functional cardiac irregularity 
(4) ; chlorosis, anemia (2, 3, 4, 5) ; bronchial and neu- 
rotic asthma (3) ; paralysis, hemiplegia, atonic incon- 
tinence of the urine, atonic retention of urine, func- 
tional paralysis, myelitis (3) ; amaurosis, paresis of the 
ocular muscles (3, 7) ; alcoholism, narcotic poisoning 
(3, 4) ; night sweats of phthisis (3). 

Contra Indications. Acute inflammatory condition 
of the spinal cord, excessive reflex irritability. 

Ignatia is identical with strychnine. 



STIMULANTS OF CIRCULATORY SYSTEM. 21 
STIMULANTS OF CIRCULATORY SYSTEM. 



ALCOHOL, 
i. External Action. Antiseptic and disinfectant. 
Hardens tissue. On skin, sense of coldness by evapo- 
ration, cutaneous vessels contracted, sweat lessened ; 
rubefacient when confined or rubbed. On mucous 
membranes, similar, but greater ; coagulates albumen 
and abstracts water, giving white, corrugated appear- 
ance, astringent. 

2. Internal Action. — Digestive Tract. Mouth, sense 
of warmth, increased flow of saliva by reflex action. 
Antiseptic. Stomach, sense of warmth, blood vessels 
dilated, therefore increased secretion of gastric juice, 
therefore moderate amounts before meals good for 
digestion in certain conditions. Taken with meals 
digestion is retarded by coagulation of albumen and 
the precipitation of pepsin. Large amounts check flow 
of gastric juice. Intestines, astringent (brandy in 
diarrhea). 

Antagonists — Cocaine, hydrocyanic acid, aconite, etc. 
Synergists — Bitters, mix vomica, etc. 

3. Blood. Amoeboid movements of white blood cor- 
puscles at first increased and then lessened. Red blood 
corpuscles hold oxyhemoglobin, therefore combustion 
is less. Obesity. (See "Temperature"). 

4. Circulation. Rate and force increased reflexly 
and by stimulation of heart muscle, also by stimulation 
of accelerator nerves. Arterial tension raised by action 
on heart, though arteries are dilated by depression of 
local vasomotor ganglia in vessel walls. Toxic doses 
depress and paralyze. 

Antagonists — Aconite, veratrum, antimony, chloral, ni- 
trites. Synergists — Digitalis, ammonia, belladonna, ergot, 
ether, etc. 



22 NOTES ON MATERIA MEDICA. 

5. Nervous System. Stimulant to brain (directly 
and by increased blood supply) in moderate doses, 
rapidity of thought and imagination stimulated ; spinal 
cord, muscles, nerves and reflexes stimulated (symp- 
toms). Larger doses followed by depression in de- 
scending order; cerebrum (incoherence of thought and 
speech), cerebellum and cord (incoordinate gait, etc.), 
loss of sensation, loss of muscular power, loss of re- 
flexes (injuries do not hurt a drunken man propor- 
tionately), involuntary micturation and defecation, 
finally depression of respiratory and circulatory cen- 
tres. 

A ntagunists— Bromides, chloral, paraldehyde, opium, 
physostigma. Synergists — Caffeine, strychnine, coca, anti- 
spasmodics. 

6. Respiration. Deepened and accelerated by mod- 
erate doses, depressed by toxic doses. Death usually 
by paralysis of respiratory centre. 

Antagonists — Hydrocyanic acid, aconite, etc. Syner- 
gists — Belladonna, strychnine, caffeine, etc. 

7. Temperature. Sense of warmth produced by in- 
creased cutaneous circulation. Temperature decreased 
by (a) lessened tissue oxidation, (b) increased radia- 
tion due to increased superficial circulation, (c) in- 
creased evaporation. Still heat is generated by the 
oxidation of alcohol. Use and abuse of alcohol in cold 
weather. 

8. Metabolism. The carbon dioxode given off 
usually increased, while nitrogenous waste is lessened. 
Alcohol is oxidized in the body adding force, but not 
tissue. Increase of tissue due to saving of other foods. 

9. Absorption and Elimination. Quickly absorbed. 
Eliminated in part by lungs, skin, kidneys and liver. 
Urine increased by raised blood pressure, but solids 



STIMULANTS OF CIRCULATORY SYSTEM. 23 

diminished. Sweat increased by stimulation of the 
glands and by increased cutaneous circulation. 

Antagonists — Belladonna, salicylic acid, etc. Syner- 
gists — Diuretics and diaphoretics. 

Poisoning. — Acute. Drunkenness. Delirium tre- 
mens, anorexia, insomnia, restlessness, tremor of 
tongue and muscles; vision and hearing; mental de- 
pression ; cold extremities ; weak pulse ; talkative 
delirium ; fear ; mania. 

Treatment. Heat, strychnine, digitalis, belladonna, 
etc., capsicum, aconite, cocaine, ipecac for vomiting. 
Purges. Chloral, bromides, etc. Fowler's solution for 
morning vomiting. Ammonium chloride in thirty 
grain doses. 

Chronic. Gastritis, cirrhosis of organs, acne rosacea, 
neuritis, paralysis, ataxia, nephritis, mental disturb- 
ances. 

Treatment. Abrupt withdrawal or tapering off. 
Isolation. Stimulant food. Danger of pneumonia. 

Administration. It should be given with food prefer- 
ably. Brandy is the best astringent. Brandy and 
champagne are the best for nausea. Whiskey is the 
least constipating, but gin is the most diuretic. Claret, 
beer and whiskey are used as stomachics. As cardiac 
stimulants use brandy or whiskey hypodermically 
hot or cold. 

Therapeutics. Contusions, sprains, indolent ulcers, 
bed sores, capillary oozing, urticaria, frost bite, pharyn- 
gitis, sore nipples, to reduce fevers, hyperhidrosis, 
swollen painful joints (1) ; atonic dyspepsia, conva- 
lescence, vomiting, gastralgia, flatulence, diarrhea 
(2) ; syncope, asphyxia, collapse, narcotic poisons, 
snake bite, adynamic heart in febril diseases (4, 5, 8) ; 
pyemia, septicemia, erysipelas, diptheria, phthisis (3, 4, 
5, 8) ; anemia, chlorosis (2, 4, 8) ; cold (9). 



24 NOTES ON MATERIA MEDICA. 

Contra Indications. Urine of high specific gravity, 
inflammatory diseases of the genito-urinary tract, dis- 
eases of the liver, gout, eczema, cardiac hypertrophy 
with excessive action. 

AMMONIA AND AMMONIUM COMPOUNDS. 

Incompatibles — Acids and acidulous salts, earthy salts, 
lime water. 

1. External Action. Applied to the skin the drug is 
a rubifacient and vesicant, but does not destroy the 
epidermis as do the other alkalies. Inhaled it produces 
by reflexes through the fifth nerve lacrymation, spasm 
and edema of the glottis. 

Antagonists — Emollients, fumes of Hcl. Synergists — 
Irritants. 

2. Internal Action. — Digestive Tract. In medicinal 
closes the drug stimulates the mucous membrane of 
the stomach, increasing secretions if given before 
meals. It counteracts acidity if given after meals. In 
concentrated or excessive closes it produces inflam- 
mation of the mucous membranes, gastro-enteritis with 
coma. 

Antagonists — Oil, etc., in poisoning. Synergists — Other 
alkalies. 

3. Nervous System. Moderate doses stimulate the 
motor tracts of the cord ; applied directly to the nerve 
tissue, it paralyzes it. Injections may cause convul- 
sions of spinal origin. 

Antagonists — Chloral, physostigma, etc. Synergists — 
Strychnine. 

4. Circulation. A rapid fleeting stimulant to the 
pulse rate and force and to the arterial tension (by 
action on accelerator nerves and heart muscle, and 
possibly the vaso-motor center also). In large 



STIMULANTS OF CIRCULATORY SYSTEM. 25 

amounts, as in intravenous injection, it paralyzes the 
muscular walls of the heart. The drug is normally 
present in the blood. In large amounts it lessens the 
oxygen-carrying power of the red blood corpuscles 
and its coagulability. 

Antagonists — Aconite, chloroform, veratrum, etc. Syn- 
ergists — Alcohol, ether, strychnine, etc. 

5. Respiration. By reflex action and by direct stimu- 
lation of the respiratory center, respirations are stimu- 
lated and become more full and more rapid. 

Antagonists — Hydrocyanic acid, chloral, opium, etc. Syn- 
ergists — Strychnine, belladonna, caffeine, ether. 

6. Absorption and Elimination. The drug is quickly 
absorbed and is partially destroyed in the body, and 
is partially eliminated by the kidneys, increasing uric 
and nitric acids, and, if given in large amounts, par- 
tially by the lungs. 

Poisoning. Ammonia is a powerful corrosive poison, 
causing gastro-enteritis, labored breathing, circulatory 
depression and muscular weakness. 

Treatment. Vegetable acids, demulcent drinks, 
opium for pain. 

Administration. Liquid preparations must be well 
diluted. As the drug is fleeting in its action, it must 
therefore be repeated at short intervals to maintain its 
effect. 

Therapeutics. Alopecia, chilblains, certain skin dis- 
eases, chronic rheumatism, inflammation of joints, 
insect bites (1) ; fainting (4, 5) ; acid stomach (2) ; 
nervous headache, alcoholism, cardiac failure, snake 
bite (4) ; pneumonia, continued fevers (4, 5) ; chronic 
bronchitis, broncho-pneumonia (5, 6) ; thrombosis (4). 

Contra Indications. Acute gastritis, excessive 



26 NOTES ON MATERIA MEDICA. 

acidity of the urine, anemia and emaciation from pro- 
longed use. 

AMMONIUM SALTS. 

Ammonium Acetate (Spirit of Mindererus). In the 
stomach like other alkalies. Diuretic or diaphoretic. 

Ammonium Benzoate. Diuretic, due to benzoic 
acid. 

Ammonium Bromide. See "Bromides. " 

Ammonium Carbonate. Probably decomposed in 
the stomach with the liberation of ammonia. Like 
ammonia in its action. Expectorant. 

Ammonium Chloride. No effect on heart or respira- 
tion, stimulant to mucous membranes, increasing secre- 
tion. Expectorant, cholagogue, purgative, in large 
dose, increases the excretion of urea. 

Ammonium Valerinate. See "Valerian." 

DIGITALIS. 

Incompatiblcs — Ferric chloride and sulphate, cinchona, 
tannic acid, lead acetate and subacetate. 

1. External Action. Slightly irritant to skin and 
readily absorbed by the skin ; slightly sedative to 
nerve terminals. 

Internal Action. — Digestive Tract. Irritant to mu- 
cous membrane (stomach and bowels), therefore avoid 
in gastritis, etc. 

2. Nervous System. Medicinal doses produce no 
effect on the general nervous system. Small toxic 
doses decrease reflex excitability by stimulation of 
inhibitory centers in the medulla, finally depressing 
the cord. Convulsions by effect of decomposition 
products of digitalis. Finally motor nerve trunks de- 
pressed and muscles paralyzed. 



STIMULANTS OF CIRCULATORY SYSTEM. 27 

3. Circulation. Heart muscle is stimulated, there- 
fore increased systole and greater pulse force. Inhibi- 
tory nerve is stimulated, causing prolonged diastole, 
and therefore greater pulse volume. Note the antago- 
nism between these two actions. Arterial tension is 
increased by the greater volume of blood and by the 
stimulation of the vaso-motor center and the local 
ganglia in the vessel walls. Digitalis acts as heart 
tonic in two ways, by stimulation of the vagus nerve, 
which is the trophic nerve of the heart, and by its 
effects on circulation. Increased volume and pro- 
longed diastole furnish more blood for a longer time 
to the heart muscle. Note that high fever prevents 
slowing by depression of the vagus nerve. 

Poisonous doses cause irregular, hobbling pulse, due 
to an inequality between the inhibitory and muscular 
stimulation, and a loss of coordination between auricles 
and ventricles (expt. heart ligated between auricles 
and ventricles ; clinical proof, stimulation of cut ends 
of vagus causes this pulse). Pulse may be rapid and 
shuttle-like, with low arterial tension due to depression 
of vaso-motor center and ganglia in the muscular walls 
of the blood vessels. Rapid pulse due to depression 
of the peripheral ends of the vagus nerves. Death by 
arrest in diastole. 

Antagonists — Aconite, veratrum, chloral, nitrites, emetics. 
Synergists — Alcohol, ammonia, etc., ergot, belladonna. 

4. Respiration. Medicinal doses no effect, poisonous 
doses cause slowing. 

5. Temperature. No effect in health. Antipyretic 
in fevers, but too slow to use for this purpose. 

6. Kidneys. Diuretic through effects on circulation. 
Digitoxin and digitalein dilate renal arteries, digitalin 
contracts general vessels, thereby raising pressure in 



28 NOTES ON MATERIA MEDICA. 

the glomeruli greatly. Watery part increased, solids 
unaffected. Spasm of vessels may occur with sup- 
pression. 

Antagonists — Nitrites, aconite, etc. Synergists — Diuretics. 

7. Absorption and Elimination. Rapidly absorbed, 
slowly eliminated, cumulative action, therefore danger 
in ascites, crisis in fever, etc. Probably oxidized in 
the body. 

Poisoning. Gastro-enteritis, rapid, irregular, com- 
pressible pulse ; syncope when patient is raised ; 
headache, double vision; exophthalmus ; blue pearli- 
ness of eye. Death by heart failure, may be in two 
or three hours or in several days. 

Treatment. Horizontal position ; tannic acid ; 
emetics (?) or stomach pump; aconite; external heat. 

Administration. Digitalin, digitalein and digitoxin 
stimulate heart muscle ; digitalin the vaso-motor cen- 
ter; digitonin depresses. Digitonin soluble in water, 
sparingly in alcohol. Digitalein is soluble in water 
and in alcohol. Digitalin insoluble in water, but freely 
in alcohol. Digitoxin slightly in both. Therefore the 
infusion contains much digitonin and little digitalin, 
and is not a powerful heart stimulant, while the tinc- 
ture and fluid extract contain little digitonin and much 
digitalin, being therefore powerful heart stimulants. 
Infusion to be used as diuretic, as spasm is avoided by 
the small amount of digitalin present, but if renal 
stasis is present and the heart weak, the tincture or 
fluid extract is better. The infusion is more irritating 
to the stomach on account of the digitonin present. 

Preparations are variable and unreliable. May be 
used hypodermically as tincture or fluid extract. Digi- 
talis leaves as poultice. Note that in children digitalis 
often causes an irregular pulse. 






Stimulants of circulatory system. 29 

Therapeutics. Acute inflammation of the joints, 
congested kidneys (i) ; valvular heart diseases, when 
compensation fails, cardiac dilatation, irritable heart, 
collapse from shock, poison or disease, low arterial 
tension, e. g., after hemorrhage, second stage of pneu- 
monia, congestion of the lungs complicating exhaust- 
ing diseases (3) ; scarlet fever (3, 6) ; delirium tre- 
mens, acute mania, epilepsy (2, 3) ; hemoptysis, 
epistaxis, menorrhagia, post-partum hemorrhage, pur- 
pura hemorrhagica, serous diarrhea, pleuritic effusion 
(3) ; cardiac or renal dropsy, chronic nephritis (6, 7). 

Contra Indications. Degeneration of the heart mus- 
cle or of the artery walls, hypertrophy, apoplexy, 
aneurism, aortic insufficiency (?). 

STROPHANTHUS. 

Compared with digitalis. 

Digestive Tract. Less irritating. 

Circulation. Does not stimulate vaso-motor center, 
therefore arterial tension is not increased except by 
increased heart action. 

Kidneys. It has no effect in dilating renal arteries. 

Elimination. It is more readily eliminated, and 
therefore has no cumulative action. 

Poisoning. Poisonous doses paralyze the heart in 
systole. Strophanthus seems to act better in children 
than digitalis. 

Administration. The tincture is the best preparation 
to use. 

Therapeutics. In cardiac diseases it is like digitalis, 
especially in irritable heart, nephritis and in children. 

CONVALLARIA. 

Compared with digitalis ; identical excepting the 
following : Less powerful ; has no cumulative action ; 
has stronger diuretic properties. 



30 NOTES ON MATERIA MEDICA. 

Convallarin is a drastic purge, and may cause nausea 
and gastric pain. 

Administration. The fluid extract is usually given. 
Therapeutics. Like digitalis. 

SCOPARIUS. (Spartein.) 

Certain points disputed. 

Digestive Tract. Spartein sulphate acts like bitters 
on the stomach. Excessive doses may cause vomiting 
and purging. 

. Circulation. Laboratory experiments have failed to 
show action on the circulation. Clinical observations 
show at first acceleration of the pulse followed by 
effects like digitalis, except that the arteries are not 
contracted, and it is not so powerful, but more rapid in 
action. 

Nervous System. Depresses brain and spinal cord. 
Reflex activity lowered through paralysis of the motor 
tracts of the cord and motor nerve endings. Large 
doses cause muscular weakness and paralysis. 

Respiration. No effect from medicinal doses. Toxic 
doses may cause death by paralysis. 

Kidneys. Diuretic by action on circulation. (Spar- 
tein not diuretic). 

Absorption and Elimination. Rapidly absorbed and 
eliminated. No cumulative action. 

Administration. Use the decoction of the drug in 
dropsy. Spartein sulphate in heart diseases given 
either internally or hypodermically. 

Therapeutics. It is like digitalis, especially in mitral 
diseases and in nephritis. 

SCILLA. 

Compared with digitalis. 

Digestive Tract. More powerful irritant to gastro- 






STIMULANTS OF CIRCULATORY SYSTEM. 31 

intestinal tract. Vomiting and purging from moderate 
doses. 

Kidneys. Excreted by the kidneys, it irritates them, 
and is therefore a more powerful diuretic. 

Expectorant. It is excreted by the bronchial mucous 
membrane, increasing vascularity and secretion, and is 
therefore a stimulant expectorant. 

Antagonists — Belladonna, opium, etc. Synergists — Ex- 
pectorants. 

In other respects it is like digitalis. 

Administration. Any preparation, given in increas- 
ing doses for diuretic. 

Therapeutics. It is like digitalis in dropsy, chronic 
pleurisy, pericarditis with effusion, sub-acute and 
chronic bronchitis. 

Contra Indications. Acute bronchitis and phthisis, 
acute nephritis. 

CIMICIFUGA. 
Internal Action. Like bitters. 
Circulation. It is like digitalis, but is milder. 
Therapeutics. Chorea, dyspepsia, bronchitis, amen- 
orrhea, dysmenorrhea, neuralgia. 

ERGOT. 

Incompatibles — Caustic alkalies, metallic salts. 

1. External Action. Applied to mucous membranes 
it is astringent and hemostatic. 

2. Internal Action. — Digestive Tract. The drug 
stimulates all involuntary muscle fiber, including the 
stomach and the intestines, thereby increasing peris- 
talsis. Large doses may irritate the gastro-intestinal 
tract, causing pain, vomiting, constipation and diar- 
rhea. 

Antagonists — Belladonna, hyoscyamus. Synergists — Phy- 
sostigma, strychnine. 



32 NOTES ON MATERIA MEDICA. 

3. Circulation. Moderate doses stimulate the vaso- 
motor center, and also the coats of the arteries, causing 
rise of arterial tension. The heart rate is slowed. 
Excessive doses may produce a fall in arterial tension 
by depression. 

Antagonists — Nitrites, chloral, aconite. Synergists — 
Belladonna, cardiac stimulants. 

4. Nervous System and Respiration. Both are de- 
pressed by large doses. 

5. Secretions. Are all diminished by the effect on 
the blood vessels (except the urine). 

Antagonist — Mercury. Synergists — Belladonna, opium. 

6. Uterus. The drug stimulates the uterine muscle 
and the uterine center in the lumbar cord, producing 
in moderate doses tonic unrelaxing uterine contrac- 
tions. In minute doses it may simply increase the 
force of the contractions of labor. 

Antagonists — Opium, chloral, viburnum. Synergists— 
Quinine, strychnine, etc. 

7. Absorption and Elimination. It is rapidly ab- 
sorbed, and is eliminated by the kidneys, stimulating 
them. 

Untoward Action. Gastro-intestinal disturbances, 
headache, chilliness, mental depression, dizziness, mus- 
cular weakness, dilated pupils. 

Poisoning. — Acute Ergotism. Symptoms. Restless- 
ness, anxiety, headache, vertigo, slow, weak pulse, 
shallow respiration, cold skin, cutaneous, anesthesia, 
dilated pupils, nausea and vomiting early or late. 

Treatment. Symptomatic. 

Poisoning. — Chronic Ergotism. Convulsive form. 
Symptoms. Tetanoid spasm of the flexor muscles, 
uterus, intestinal muscles and muscles of respiration ; 
cataract. ' Gangrenous form. Symptoms. Coldness 






STIMULANTS OF RESPIRATORY SYSTEM. 33 

and numbness, formication, loss of sensibility, bullae, 
gangrene, spinal cord changes from anemia. 

Administration. Give the fluid extract by mouth for 
uterine effects. Ergotin or non-alcoholic preparations 
are preferable for hypodermic use. 

Therapeutics. Nasal hypertrophies, prolapse of the 
rectum, hemorrhoids (1), obstetrics, post-partum 
uterine hemorrhage, subinvolution," submucous uterine 
fibroids, polypi, congestive dysmenorrhea, menorrha- 
gia, chronic mitritis (6) ; chronic diarrhea and dysen- 
tery (2, 3) ; incontinence of urine due to paresis of the 
bladder (2) ; cerebral hyperemia, cerebro-spinal men- 
ingitis, congestion of the spine, congestive headache, 
erythema, urticaria, various forms of hemorrhage, pur- 
pura, acne. 

Contra Indications. The first stage of labor ; cere- 
bral and spinal anemia. 



STIMULANTS OF RESPIRATORY SYSTEM. 

BELLADONNA.— Atropine. 

Incompatibles — Tannic acid, caustic alkalies. 
i. External Action. — Skin. The drug is absorbed 
from the unbroken skin producing constitutional symp- 
toms. Locally causes paralysis of the secretory and 
sensory nerve terminals, and contracts blood vessels ; 
it is therefore a local anodyne, and checks secretions. 
Antagonists — Irritants. Synergists — Aconite, hydrocyanic 
acid, etc. 

Eye. Stimulates the end organs of the sympathetic 
nerves (radiating fibers), and paralyzes the motor 
oculi (circular fibers), producing dilatation of the 
pupil and paralysis of accommodation. Intra-ocular 
pressure is increased (canal of Schlemm). 

Antagonist — Physostigma. Synergists — Cocaine, stramo- 
nium, hyoscyamus. 



34 NOTES ON MATERIA MEDICA. 

2. Internal Action. — Digestive Tract. Lessens 
secretions of saliva, gastric and intestinal juices by 
paralyzing the secretory nerve terminals. Minute 
doses increase peristalsis (paralysis of inhibitory nerve 
terminals), moderate doses lessen peristalsis (paralysis 
motor nerve terminals and ganglia in gut wall) ; large 
doses stop peristalsis (paralysis of muscles). 

Antagonists — Cathartics, strychnine. Synergists — Opium, 
astringents, etc. 

3. Circulation. Heart muscle and accelerator nerves 
are stimulated, inhibitory nerves are at first stimulated, 
later they are paralyzed in their peripheral ends, there- 
fore the pulse is at first slow and then rapid. The vaso- 
motor center is powerfully stimulated, increasing arte- 
rial tension; large doses paralyze the vasomotor 
center, causing relaxation of the blood vessels. Death 
by vasomotor paralysis. 

Antagonists — Aconite, nitrites, opium, chloroform. Syn^- 
crgists — Strychnine, ergot, digitalis, etc. 

4. Nervous System. Brain. Congested ; higher 
centers first stimulated and then depressed, therefore 
headache, vertigo, delirium, followed by sleep, stupor 
or rarely by coma (not like the coma of opium). Cord. 
Motor centers at first stimulated (increased reflexes, 
convulsions), then depressed (paralysis of third to 
tenth dorsal especially). Nerves. Peripheral ends 
of sensory nerves are depressed by local action (sensa- 
tion is somewhat impaired, but drug is not a general 
anodyne). Involuntary muscles relaxed. 

Antagonists — Chloral, bromides, opium, etc. Synergists — 
Strychnine, coca, caffeine. 

5. Respiration. Respiratory center is powerfully 
stimulated, quickening and deepening the action (peri- 
pheral ends of vagi nerves are depressed, therefore the 
effects are irregular). Bronchial secretions diminished 



STIMULANTS OF RESPIRATORY SYSTEM. 35 

by paralysis of secretory nerve terminals. Death by 
respiratory failure. 

Antagonists— Hydrocyanic acid, chloral aconite, opium. 
Synergists — Strychnine, ammonia, caffeine. 

6. Temperature. Increased by large doses through 
influence on respiration and circulation ; falls rapidly 
in poisoning. 

7. Skin. Secretion is checked by paralysis of secre- 
tory nerve terminals, scarlet eruption, desquamation. 

Antagonists— Pilocarpine, opium. Synergists — Salicylic 
acid, etc. 

8. Kidneys. Urine increased by increased arterial 
tension (not universally observed). All other secre- 
tions diminished. 

Antagonist — Opium. Synergists. — Diuretics. 

9. Absorption and Elimination. The drug is quickly 
absorbed and rapidly eliminated, chiefly by the kid- 
neys, but also by the bowels. It lessens the irritability 
and muscular power of the bladder (retention). 

Untoward Action. Dry red throat and skin, dilated 
pupils, disturbed vision, erythematous eruption, hallu- 
cinations. 

Poisoning. Symptoms. Great dryness and thirst, 
dilatation of the pupils, blindness, whole surface of the 
body red and dry ; pulse increasing in rapidity and 
feebleness, respiration at first stimulated, but fails from 
over-stimulation, urine expelled with erections, later 
retention, desire for exercise, but muscular weakness, 
delirium at first gay, later falling into stupor ; convul- 
sions ; paralysis. 

Treatment. Tannic acid, stomach pump, strychnine, 
digitalis, whiskey, opium, physostigma, pilocarpine, 
external heat. 

Administration. Though a narcotic drug, bella- 
donna is well borne by children. Administer every 



36 ' NOTES ON MATERIA MEDICA. 

three to six hours, but watch for untoward symptoms. 
Give apart from meals. 

Therapeutics. Boils, carbuncles, chronic inflamma- 
tion of the joints, orchitis, hemorrhoids, anal fissure, 
eczema, hyperidrosis, acute and chronic muscular rheu- 
matism, neuralgia (i) ; gastralgia, constipation (2) ; 
lumbago, neuralgia, pleurodynia (4) ; lactation, saliva- 
tion, sweating, serous diarrhea (3, 8) ; incontinence 
of urine (9) ; colic, cystitis, prostatitis, spermatorrhea, 
goiter, cerebral and spinal hyperemia, menorrhagia, 
congestion of the lungs (3, 4) ; Physostigma and pilo- 
carpine poisoning (3, 4, 5) ; weak heart of fevers, etc., 
relaxed blood vessels, pneumonia, pleurisy (3) ; in the 
eye, to dilate the pupil, to prevent adhesions, to remove 
congestion, to relieve pain, to give rest (1) ; any spasm 
of involuntary muscle fiber (4). 

ATROPINE. MORPHINE. 

Stimulates respiration. Depresses respiration. 

Dilates pupil. Contracts pupil. 

Reddens skin. Causes palor. 

Increases temperature. Decreases temperature. 

Both lessen peristalsis. 
Stimulates kidney. Depresses kidney. 

Lessens sweat. Increases sweat. 

Checks secretion through Checks secretion through 
peripheral nerves. centers in the medulla. 

Lessens sensation through Lessens sensation through 
peripheral nerves. centers and tracts of the 

Cerebral excitant (short cord. 

sleep). Cerebral depressant (long 

Contracts arterioles. sleep). 

Dilates arterioles. 
Both relieve pain. 

Both cause incoordination of muscles. 
Both produce mental confusion. 



STIMULANTS OF RESPIRATORY SYSTEM. 37 

STRAMONIUM. 

Its action is identical with that of belladonna, except 
in the following points: 

Nervous System. More effect on sympathetic 
nerves, less on motor and sensory nerves. 

Circulation. Heart action sometimes irregular. 

Respiration. Muscle fibers of the bronchial tubes 
are more relaxed than by the action of belladonna. 

Poison. Drug causes more delirium than belladonna. 

Administration. Cigarettes of the leaves should be 
smoked for asthma. Any of the preparations may be 
given internally. 

Therapeutics. It is like belladonna, but is better in 
spasmodic asthma and painful hemorrhoids. 

Contra Indications. As for belladonna. 

HYOSCYAMUS. (Henbane.) 

Its action is identical with that of belladonna, except 
in the following points : 

Internal Action. — Digestive Tract. Less depressant 
to peristalsis, but relieves griping more. 

Circulation. Less powerful than belladonna, more 
powerful than stramonium. 

Nervous System. Less powerful cerebral excitant, 
more powerful hypnotic, cerebral and spinal sedative 
(hyoscine). 

Respiration. Less powerful sedative than bella- 
donna. 

Urinary Tract. More powerful sedative than bella- 
donna. 

HYOSCYAMINE. 

I Like atropine, but less powerful, more anodyne and 
anesthetic than narcotic. Cerebral stimulant, spinal 
depressant. 



38 NOTES ON MATERIA MfiDICA. 

HYOSCINE. 

Cerebral and spinal sedative, hypnotic, depressing 
the higher centers, and having special effect on motor 
cord and cerebral cortex. 

Administration. Any preparations. Begin with 
small dose. Alkaloids hypodermically or by mouth. 
Hyoscine is tasteless. 

Therapeutics. It is like belladonna, but is better in 
incontinence of urine, vesical tenesmus, etc. For colic 
to allay griping. For delirium tremens, mania, in- 
somnia, hysterical convulsions, cholera, etc. 

Contra Indications. As for belladonna. 



DEPRESSANTS OF THE NERVOUS SYSTEM. 

OPIUM. 

Incompatibles — Tannic acid, caustic alkalies, metallic salts. 

i. External Action. Slightly anodyne. On broken 
skin or mucous membranes it reduces sensitiveness of 
nerve terminals, and is readily absorbable. 

Antagonists — Irritants. Synergists — Belladonna, cocaine. 

2. Internal Action. All secretions diminished except 
sweat. Digestive Tract. Mouth. Flow of saliva 
checked. Stomach and Intestines. All secretions 
diminished. Medicinal doses lessen peristalsis by 
stimulation of the inhibitory fibers of the splanchnic 
nerve ; hence constipation. Very large doses, or long 
continued, paralyze inhibitory fibers; hence diarrhea. 
Reflex constipation relieved by depressant effect of 
opium on nerve terminals. 

Antagonists — 'Cathartics, strychnine. Synergists — Astrin- 
gents. 

3. Circulation. Heart. Small doses stimulate inhibi- 
tory fibers centrally and peripherally, stimulate heart 



DEPRESSANTS OF THE NERVOUS SYSTEM. 39 

muscle and ganglia, hence slow, full, strong pulse ; 
large doses and continued doses depress the inhibitory 
nerve fibers and heart muscle, hence rapid, weak pulse 
unless heart muscle is exhausted, when slow, weak 
pulse results. Vasomotor system. Some dilatation of 
cutaneous blood vessels, increased arterial tension due 
to increased heart action. Very large or poisonous 
doses paralyze the vasomotor system. Habitual use 
contracts cutaneous blood vessels (pallor). 

Antagonists — Aconite, antimony, chloroform, nitrites. 
Synergists — Strychnine, belladonna, caffeine, etc. 

4. Respiration. The center in the medulla is some- 
times stimulated by small doses, large ones depress 
and paralyze. Death by paralysis of respiration. 

Antagonists — Belladonna, strychnine, ammonia, caffeine. 
Synergists — Hydrocyanic acid, chloral, aconite, chloroform. 

5. Nervous System. Brain. In its general action it 
is depressant to the brain. Different effects on chil- 
dren, animals and adults. Stimulates higher centers, 
and increases circulation of the brain, stimulates imagi- 
nation, and depresses inhibition. This is followed by 
depression and sleep ; dreams, good or bad, caused by 
depression of cortical cells and anemia of the brain, 
next it acts on the basal ganglia (vomiting, contracted 
pupil, etc.). Cord. Short period of stimulation, then 
depression of sensory tracts, cerebral and spinal centers 
and nerve terminals ; motor tracts at first stimulated, 
and then depressed (convulsions, inability to stand, 
etc.), reflexes diminished and abolished, muscles un- 
affected. 

Antagonists — Strychnine, belladonna, caffeine, cocaine. 
Synergists — Chloral, bromides, trional, gelsemium, etc. 

6. Temperature. Slightly raised by medicinal doses, 
lowered after diaphoresis and by lethal doses. 



40 NOTES ON MATERIA MEDICA. 

7. Eye. Pupil contracted probably by the stimula- 
tion of the oculo-motor nerve, possibly by the depres- 
sion of the sympathetic nerve. 

8. Skin. Sweat glands are stimulated, increasing 
sweat (probably due to the effects of venous blood on 
the sweat center). 

Antagonist — Belladonna. Synergists — Ipecac, pilocarpus. 

9. Uterus. Depressed. Menstruation checked. The 
drug may cause impotence in males. 

Antagonist — Emmenagogues. Synergist — Viburnum. 

10. Metabolism. Lessened (less carbon dioxide and 
urea) ; liver function impaired, decrease in sugar in 
diabetes. 

11. Absorption and Elimination. The drug is 
quickly absorbed, and is eliminated by the stomach as 
morphine (lavage) ; by the milk (new-born children) ; 
by the kidneys (effect on urinary tract) ; by the skin 
(rash, itching). It is probably partially destroyed in 
the liver. 

Untoward Action. Excitement, wakefulness, nausea 
and vomiting, itching and rash, etc. 

Poisoning. — Acute. Symptoms. Excitement, then 
sleep; variable time; patient wakes with dry mouth. 
Coma, patient roused with difficulty, respiration slow 
and strong, skin warm and dry, diminished reflexes, 
prostration, pupils contracted until death approaches, 
then skin moist and clammy, temperature falls, cyano- 
sis, pulse rapid and feeble, respiration slow and irregu- 
lar, abolished reflexes. Death is due to respiratory 
failure, not to sleep. 

Treatment. Emetics, stomach pump, tannin, potas- 
sium permanganate, strychnine, coffee, douches, exer- 
cise, flagellation, faradic battery, external heat. 

Chronic. Symptoms. Nervous tremors and nerv- 






DEPRESSANTS OF THE NERVOUS SYSTEM. 41 

ousness, hallucinations, hypochondria, anxiety, in- 
somnia, spasms, neuralgia, neuritis, vesical irritation, 
constipation or diarrhea, disturbance of sexual func- 
tions, mental and moral degeneracy. 

Treatment. Withdrawal of the drug suddenly or 
gradually under absolute espionage, tonics, hygiene. 
(Surgical operations on opium habitues.) 

Administration. Habit is formed so insidiously that 
it is best to avoid the use of opium if possible, espe- 
cially in persons of nervous temperament. Children 
bear opium very badly. Idiosyncrasy is common with 
this drug. The drug may accumulate in the system. 
If prolonged administration is necessary, begin with 
small dose and increase gradually. Age, sex, condi- 
tion of the patient influence the action of the drug, so 
that the dosage and interval of administration cannot 
be definitely stated. 

Therapeutics. To relieve pain, to produce sleep, to 
lessen reflex irritation, to diminish secretion, to pro- 
duce sweating. Conjunctivitis, painful condition of 
the urethra, ear, nose and throat (1) ; delusions of 
delirium tremens or mania, spasm of involuntary 
muscles, condition of tetanus, uremia, etc. (5, 11); 
congestive chill (3, 5) ; dysentery, cholera morbus, 
cholera (2) ; coryza, bronchitis (8, 3) ; peritonitis (2, 
3, 5) ; shock (3, 4, 5) ; pleurisy (3, 4) ; passive hemor- 
rhage (3) ; debility of fevers (3, 4, 5). 

Contra Indications. Children, neurotic persons, ex- 
cessive bronchial secretions of the aged, the second 
stage of pneumonia, cerebral congestion, alcoholism. 

MORPHINE. 

Incompatibles — Iodine, iodides, bromine, bromides, Fow- 
ler's solution, sodium borate. 
Has in general the action of opium, but without its 
convulsive effects, but with the following differences : 



42 NOTES ON MATERIA MEDICA. 

It is less constipating, less stimulating, more sedative, 
more anodyne, more hypnotic, causes more pruritus. 

CODEINE. 

Less hypnotic than morphine, more stimulant to 
spinal cord, special sedative to the pneumogastric 
nerve, hence analgesic to abdominal viscera. 



HYPNOTICS. 

CHLORAL. 

Incompatibles — Alkalies. 
Chloral seems at first to produce brief stimulation 
of the heart and nervous system, but its dominant 
action is as follows : 

1. External Action. An irritant to skin and mucous 
membranes producing burning, ulcerations, vesication, 
and is also an anesthetic and antiseptic. 

Antagonists — Emollients. Synergists — Local anesthetics 
and antiseptics. 

2. Internal Action. — Digestive Tract. In mouth and 
stomach it causes burning and irritation. 

3. Nervous System. The drug is a powerful hyp- 
notic, producing natural sleep by its depressant action 
on the higher centers of the cortex and by anemia of 
the brain ; no headache. It depresses the motor cen- 
ters and tracts of the cord and the motor nerves, 
diminished reflexes, sensory receptive centers of the 
cord may be depressed, but the drug is not an anodyne. 

Antagonists — Strychnine, belladonna, caffeine, coca. Syn- 
ergists — Bromides, opium, chloroform, physostigma. 

4. Respiration. Moderate doses produce no effect ; 
large ones depress, the act becoming shallower ; toxic 
doses paralyze the respiratory center. 

Antagonists — Strychnine, belladonna, caffeine, ammonia. 
Synergists — Hydrocyanic acid, opium, aconite. 



HYPNOTICS. 43 

5. Circulation. Blood. Excessive doses produce 
crenation of the red blood corpuscles and diminution 
of the white blood corpuscles. Heart. Small doses 
have no effect; large doses are depressant to cardiac 
ganglia and muscles, pulse becoming slow and weak 
and later weak and running. Arterial tension. Les- 
sened by depression of the vasomotor center and 
nerves ; dilatation of the superficial vessels. 

Antagonists — Alcohol, ammonia, strychnine, belladonna, 
morphine, digitalis. Synergists — Aconite, chloroform, etc. 

6. Temperature. Lessened and under large doses 
markedly reduced ; this is due to lessened oxidation 
of the body cells and increased elimination through 
the dilatation of the superficial vessels. 

7. Eye. Continued use causes contracted pupil by 
paralysis of the sympathetic nerve. 

8. Absorption and Elimination. The drug is rapidly 
absorbed, producing effects in from fifteen to thirty 
minutes. It is partially eliminated by the skin, and 
may by its irritant action cause erythematous rash, 
papules and vesicles. Quasi purpura hemorrhagica. 
It is chiefly eliminated by the kidneys as urochloralic 
acid, and may produce irritation of the urinary tract, 
causing bloody urine, etc. Urine responds to Fehling's 
test for sugar. 

Untoward Action. Anxiety, restlessness, disturb- 
ance of respiration, disturbance of vision, rash. 

Poisoning. — Acute. Symptoms. Respiration is at 
first slow and labored, then .slow and feeble ; circula- 
tion is at first slow and then rapid and weak, disap- 
pearing at the wrist, face white and livid, body covered 
with clammy sweat, temperature markedly reduced, 
pupils contracted, then dilated, muscular relaxation, 
abolished reflexes. Death by respiratory or cardiac 
failure. 



44 notes on Materia medica, 

Treatment. Emetics, stomach pump, external heat, 
keep head low, digitalis, strychnine, atropine, artificial 
respiration. 

Poisoning. — Chronic. Symptoms. Anemia, muscu- 
lar weakness, weak irritable heart, hepatic derange- 
ment, vasomotor disturbances (sudden flushings, etc.), 
respiratory irregularity, mental depression, insomnia, 
excitable speech and action, insanity. 

Treatment. Withdrawal of the drug suddenly or 
gradually, tonics, hygiene. 

Administration. Children bear chloral fairly well. 
On account of the irritant qualities of the drug it 
should be well diluted, using some aromatic liquid to 
disguise the taste. Administration to be repeated ac- 
cording to indications. 

Therapeutics. Hydrocele, cancer, foul ulcers, gonor- 
rhea, bromidrosis, hyperidrosis, anal fissure, cracked 
nipples (i) ; insomnia, delirium tremens, puerperal 
mania, uremic convulsions, spasmodic disorders, 
chorea, whooping-cough, infantile convulsions, asthma, 
tetanus, hiccough, strychnine poisoning, puerperal con- 
vulsions, epilepsy, reflex vomiting, rigid os, labor pains, 
neuralgia, nervous irritability, restlessness of sthenic 
fevers, scarlet fever (3). 

Contra Indications. Fatty heart, weak respiration, 
acute inflammatory rheumatism, atheromatous blood 
vessels, neurotic persons. 

CHLORALAMIDUM. 
Compared with chloral. 
External Action. Less irritating. 
Internal Action.— Digestive Tract. Like chloral. 
Circulation. Very feeble action if any. 
Nervous System. Acts on cerebral cortex like 
chloral, but is less depressing to motor cord ; analgesic. 



HYPNOTICS. 45 

Respiration. Stimulated by small doses, depressed 
by large. 

Urine. Diminished. 

Temperature. Unaffected. 

Poisoning. — Acute. Like chloral. 

Poisoning. — Chronic. There is no tendency toward 
the formation of the habit. 

Therapeutics. Its action when given internally is 
like that of chloral. It is also used in neurasthenic 
insomnia and sea-sickness. 

CHLORETONE. 

Internal Action. — Stomach. Sedative to sensory 
nerve terminals, locally anesthetic. 

Circulation. Not as depressing as chloral. 

Respiration. Not as depressing as chloral. - 

Nervous System. Hypnotic like chloral and anes- 
thetic (depression of the sensory nerve terminals ?). 

CHLORALOSE. 

Identical in action with chloral, except that it is 
more depressant to the cerebrum, and is more stimu- 
lant to the spinal cord. It is more anodyne than 
chloral. It is uncertain in its action. 

CROTON CHLORAL. 

Identical in its action with chloral, except it is pos- 
sibly less depressant to the heart and has a specific 
action of relieving neuralgia of the fifth nerve. 

Therapeutics. It is like chloral. It is also used in 
headache, facial neuralgia and migraine. 

CAMPHOR CHLORAL. 

Used only externally; depresses sensory nerve ter- 
minals, anesthetic. 



46 NOTES ON MATERIA MEDICA. 

HYPNAL. 
Like chloral, except that it is more antispasmodic 
and theoretically more anodyne. It is more irritating 
to the stomach. 

URETHANE. 
Allied to chloral, but less depressant to circulation 
and respiration, more depressant to motor nerve termi- 
nals, not so reliable as a hypnotic. 

THE BROMIDES. 

Incompatiblcs — Acid and metallic salts, acids ; spirit of 
nitrous ether with ammonium bromide. 

External Action. None. 

1. Internal Action. — Digestive Tract. Slightly seda- 
tive to pharyngeal mucous membrane, irritant to 
stomach if continued. 

2. Nervous System. Depressant to intellectual and 
motor cortical centers, somnolence ; continued use may 
impair memory and intellect. Cerebral circulation les- 
sened. Depressant to peripheral sensory nerves and 
tracts in the cord. Later it depresses the motor nerves, 
diminishes reflexes and depresses sexual functions. 

Antagonists — Strychnine, caffeine, coca. Synergists — 
Chloral, opium, acetanilia, antipyrin, etc. 

3. Respiration. Medicinal doses have no effect. 
Large doses depress respiratory center. 

Antagonists — Belladonna, strychnine, etc. Synergists — 
Chloral, aconite, hydrocyanic. 

4. Circulation. Heart rate and force diminished by 
depressant action on heart muscle. Large doses lower 
arterial tension, though the vessels are reduced in size. 
Therapeutic doses produce no marked effect. 

Antagonists — Alcohol, belladonna, strychnine, caffeine, 
digitalis, ergot, etc. Synergists — Aconite, nitrites, chloro- 
form, etc. 



HYPNOTICS. 47 

5. Temperature. No marked effect caused by medi- 
cinal doses. Large doses cause a fall. 

6. Skin. Irritated in course of elimination. 

Antagonist — Fowler's solution. 

7. Absorption and Elimination. Very rapidly ab- 
sorbed. It is eliminated by the kidneys chiefly, par- 
tially by all avenues. Elimination is slow, therefore 
there is danger of cumulative effects and bromism. 

Untoward Action. Nausea, coryza, bronchitis, 
cough, bad breath, depression of the genito-urinary 
tract, nervousness. 

Poisoning. — Bromism. Acne, fetid breath, pallor, 
emaciation, special senses depressed, motor power 
diminished, mental dullness, melancholia with suicidal 
intent, moroseness, mental aberration. 

Treatment. Withdrawal of the drug, arsenic for 
acne, salol for intestinal antisepsis, purgatives, stimu- 
lants. 

Administration. Because of the irritant action of 
these preparations, they should be always given well 
diluted. Frequency of repetition depends on the con- 
ditions. 

Therapeutics. Pharyngitis (1) ; insomnia, cerebral 
congestion, epilepsy, reflex convulsions, strychnine 
poisoning, tetanus, nervous irritability, delirium tre- 
mens, delirium of fevers, cinchonism (2) ; cardiac irri- 
tability (4). 

Contra Indications. Great debility, anemia, fatty or 
weak heart and low arterial tension. 

THE BROMIDES COMPARED. 
Potassium Bromide. This is the most toxic to heart 
and muscles, less hypnotic. 

Sodium Bromide. Is most hypnotic, has more effect 



48 NOTES ON MATERIA MEDICA. 

on the circulation, and is less irritant to the stomach 
than potassium bromide. 

Lithium Bromide. Resembles the sodium salt, more 
hypnotic than the potassium salt. 

Ammonium Bromide. Resembles the potassium 
salt, but is less depressant to the heart and muscular 
system. 

Calcium Bromide. Good hypnotic, less irritant than 
the potassium salt. 

Strontium Bromide. Mildest of all, less apt to cause 
acne. 

Zinc Bromide. Very irritant. 
Gold Bromide. Very depressing to cortical cells. 
Dilute Hydrobromic Acid. Like the bromides, but 
less depressant and less poisonous. 

SULPHONAL. 

Incompatiblcs — None specially. Drug usually given alone. 

i. Internal Action. — Digestive Tract. Medicinal 
doses have no effect. Toxic doses may cause nausea, 
vomiting and gastric pain. 

2. Nervous System. The higher centers of the brain 
are depressed, producing sleep. Motor nerves are not 
affected, but the drug may produce a staggering gait 
and muscular relaxation. Sensory nerves are un- 
affected. Sleep is quiet, but giddiness or drowsiness 
is apt to ensue the next day. Reflex excitability les- 
sened by stimulation of the reflex inhibitory center. 

Antagonists — Caffeine, coca, alcohol, etc. Synergists — 
Chloral, opium, bromides, etc. ; antispasmodics. 

3. Circulation. Usually is unaffected, but it may 
cause a slight rise in arterial tension, and slightly in- 
crease the cardiac action. 



HYPNOTICS. 49 

4. Respiration. Medicinal doses produce no effect; 
full doses may depress. 

Antagonists — Respiratory stimulants. Synergists — Respi- 
ratory depressants. 

5. Absorption and Elimination. Absorption is very 
slow. The drug is largely changed in the body, but if 
given in large doses, may be partially eliminated by 
the kidneys. 

Poisoning. Symptoms. Derangement of the diges- 
tive tract, vertigo, weakness, tremor of the limbs, in- 
capability for mental or physical work, drowsiness, 
diminished urine, casts, blood, hematoporphyrinuria. 

Treatment. Withdrawal of the drug, stimulants, 
tonics, etc. 

Administration. Prolonged use diminishes hypnotic 
effect. Action of the drug is slow and prolonged, 
taking from two to four hours to produce effect. The 
dose is difficult to determine. It should always be 
given in powder or capsules with hot milk or whiskey 
to hurry absorption and effects. 

Therapeutics. Insomnia, excitement of insanity, 
nervous irritability (2). 

TRIONAL. 

Action is not well understood. It is depressant to 
the cortical areas of the brain, producing sleep. 1 )i- 
minishes arterial tension somewhat. 

Poisoning. Symptoms and treatment are the same 
as for sulphonal. 

Comparison with Sulphonal. Its action is much 
more prompt, effects observed in about one hour, and 
the effects are not so long continued. 

HUMULUS. (Hops.) 
Incompatibles — Mineral acids, metallic salts. 
i. External Action. It is mildly sedative and astrin- 
gent. 



5o 



NOTES ON MATERIA MEDICA. 



2. Internal Action. — Digestive Tract. It is like the 
bitters stimulating salivary and gastric glands. 

Antagonists — Opium, belladonna, gastric sedatives. Syn- 
ergists — Strychnine, bitters, etc. 

3. Circulation. Heart rate and arterial tension are 
increased slightly. 

4. Nervous System. At first mildly stimulant, and 
then mildly sedative to brain (soporific), the action of 
the alcoholic preparations is more pronounced. 

Antagonists — Strychnine, caffeine, coca. Synergists — 
Hypnotics. 

5. Respiration. It is slightly stimulated. 

6. Absorption and Elimination. The drug is rapidly 
absorbed, and is eliminated by the skin and kidneys, 
stimulating their function. 

Administration. Tincture, fluid extract and syrup 
are usual forms in which this drug is administered. 
Give lupulin in pills. 

Therapeutics. Orchitis, ear-ache (1) ; atonic dys- 
pepsia, flatulent colic (2) ; alcoholism, delirium tre- 
mens (4). 

PARALDEHYDUM. 

External Action. Mildly antiseptic. 

Internal Action. — Digestive Tract. It often irritates. 
Has unpleasant taste. 

Circulation. It tends to slow and to strengthen the 
pulse. Toxic doses depress. 

Nervous System. Like chloral, but the effects are 
of shorter duration, and there are no bad after effects. 

Temperature. Is slightly lowered. 

Respiration. Its effects on respiration are like those 
pf chloral, but it is not so depressing. Toxic doses 
cause death by paralysis of the respiratory center. 



ANALGESICS. 5 X 

Absorption and Elimination. It is rapidly absorbed 
and is eliminated by the kidneys and the lungs. 

Poisoning. Like chloral. 

Administration. Give in capsules, flavored water or 
in milk. 

Therapeutics. Like chloral. 



ANALGESICS. 

ACETANILID. 

Incompatible s — Potassium and sodium hydrates, chloroform. 
r. External Action. Mildly sedative, antiseptic and 
anesthetic. Astringent to mucous membranes. 

• Antagonists — Irritants. Synergists — Cocaine, aconite, etc. 

2. Internal Action. Mildly sedative to the gastric 
mucous membrane. 

Antagonists — Irritants. Synergists — Cocaine, aconite, 
hydrocyanic acid. 

3. Circulation. Lleart. Medicinal doses produce no 
effect ; large doses depress. Arterial tension. Low- 
ered by large doses through paralysis of the vasomotor 
center. Blood. Medicinal doses produce no change 
unless through idiosyncrasy. Under large doses it 
turns brownish, methemoglobin is formed, the ozoniz- 
ing and oxygen carrying power of the blood is dimin- 
ished and normal alkalinity is decreased. 

Antagonists — Strychnine, belladonna, caffeine, —digitalis, 
etc. Synergists — Aconite, chloral, etc. 

4. Nervous System. Depressant to sensory nerves 
and to cord (analgesic and lessened reflexes). Toxic 
doses abolish reflexes and paralyze both sensory and 
motor tracts. 

Antagonists — Strychnine, caffeine, eto. Synergists — 
Opium, chloral, bromides, etc. 



52 NOTES ON MATERIA MEDICA. 

5. Respiration. Moderate doses have no effect. 
Large doses cause rapid impaired breathing, due to 
condition of the blood, paralysis of peripheral motor 
nerves, and depression of the respiratory center. 
Death by respiratory paralysis. 

Antagonists — Belladonna, strychnine, caffeine, ammonia. 
Synergists — Hydrocyanic acid, opium, etc. 

6. Temperature. No effect on normal temperature 
by medicinal doses. In fever temperature falls rapidly, 
due to action on the thermogenic center ( not by effect 
on blood, not by sweating). 

7. Skin. Free diaphoresis. 

Antagonist — Belladonna. Synergists — Pilocarpus, opium, 
etc. 

8. Absorption and Elimination. The drug is rapidly 
absorbed, effects being produced in half an hour. It is 
eliminated by the kidneys, acting as a diuretic, and 
causing an increase in urea and uric acid. 

Untoward Action. Cyanosis, anxious expression, 
rash, sneezing, prolonged use may cause congestion 
of the internal organs and fatty degeneration. 

Poisoning. Symptoms. Cyanosis, anxious expres- 
sion, profuse cold sweat, vomiting, slow weak pulse, 
respiration rapid and labored, or slow and shallow. 

Treatment. Diffusable stimulants, circulatory and 
respiratory, external heat, oxygen inhalations. 

Administration. All drugs of this class must be care- 
fully used on account of the possible depressant effects 
to circulation and respiration. They may be admin- 
istered every three to four hours. 

Therapeutics. Chancre, chancroid, epistaxis, hem- 
optysis, congestion of the nose and throat (1) ; sthenic 
fevers (6) ; rheumatism, locomotor-ataxia, neuralgias, 
neuritis, lumbago, gastralgia, dysmenorrhea, sciatica, 
headache, chorea, epilepsy, whooping-cough, grippe (4). 



ANALGESICS. 53 

Contra Indications. Low fevers, fatty heart, blood 
disorders, exhausted condition. 

ANTIPYRIN. 
Incompatibles — Nitrous compounds, chlorides of mercury, 
iodides of arsenic and mercury, iodine, ferric salts, car- 
bolic acid, chloral, sodium bicarbonate and salicylate, salts 
of quinine and caffeine. 

External Action. Local anesthetic, hemostatic, anti- 
septic. 

Internal Action. Like acetanilid, except in the fol- 
lowing points: It is irritating to the stomach and diges- 
tive tract; this irritation may cause nausea and vomit- 
ing. 

Respiration. Rate is increased by medicinal doses. 

Absorption and Elimination. More rapidly elimi- 
nated than acetanilid, diminishes the amount of urea 
and uric acid. 

Antagonists and Synergists as for Acetanilid. 

Administration. In powders, capsules or in solution. 

Therapeutics. Like acetanilid, but is a more power- 
ful antiseptic, local anesthetic and analgesic. Diabetes 
mellitus, intermittent fevers. 

PHENACETIN. 

Action not well understood ; like acetanilid, except 
in the following points : 

Circulation. Small doses raise force and rate of heart 
beat, and cause a rise in the arterial tension. 

Kidneys. Not so actively diuretic. Large doses ren- 
der urine dark and yellow, and produce the reaction of 
the sugar test. Less powerful analgesic, slow anti- 
pyretic. 

Administration, therapeutics and contra indica- 
tions like acetanilid. 



54 



NOTES ON MATERIA MEDICA. 



PHENOCOLL HYDROCHLORIDE, 

Incompatibles — Alkalies. 

Like acetanilid, except in the following points : 

It does not disintegrate the blood, reduces fever 
markedly, but without profuse sweating. 

Administration. Give in powders or in capsules or 
in solution. 

Therapeutics. It ranks next to quinine as an anti- 
periodic, without the unpleasant after effects. 

EXALGIN. 

Compared with acetanilid, it is less antipyretic, in- 
creasing arterial tension. It is unsafe. 

Administration. Not oftener than every six to eight 
hours. 

Therapeutics. Like acetanilid. 

Contra Indications. Fever and like acetanilid. 



MOTOR DEPRESSANTS. 

PHYSOSTIGMA. 

Incompatibles — Caustic alkalies, tannic acid. 
i. External Action. Skin, no effect. Eye, contracts 
pupil and causes spasm of the ciliary muscle through 
irritation of the third nerve and paralysis of the ends 
of the sympathetic nerve ; fall of intra-ocular tension 
(lessened secretion, contracted pupils, contracted ves- 
sels) ; myopia. 

Antagonists — Atropine, cocaine. 

2. Internal Action. Stimulant to unstriped muscle 
fiber. 

Antagonist — Belladonna. Synergist — Ergot. 

3. Digestive Tract. At first stimulant to salivary, 
gastric and intestinal secretions, followed by dimin- 



MOTOR DEPRESSANTS. 55 

ished secretions. May cause nausea and vomiting, 
stimulates muscular coat of the stomach and intestines, 
thus increasing peristalsis — diarrhea. 

Antagonists — Belladonna, opium, 'etc. Synergists — Alco- 
hol, bitters, strychnine. 

4. Nervous System. Brain, unaffected. Cord, de- 
pression of the motor tracts and centers, diminished 
reflexes ; muscles unaffected, but a sense of muscular 
debility is felt. 

Antagonists — Strychnine, coca, caffeine. Synergists — 
Choral, bromides, gelsemium, opium, etc. 

5. Circulation. Blood, unaffected. Heart, slowed by 
stimulation of the peripheral endings of the vagus. 
Force of contractions increased by stimulation of the 
heart muscles ; arterial tension is raised by increased 
heart force and stimulation of the muscles in the artery 
walls. Overdose causes depression of the circulation. 

Antagonists — Nitrites, aconite, veratrum. Synergists — 
Belladonna, ergot, heart stimulants. 

6. Respiration. No marked effect produced by mod- 
erate doses. Under large doses, action is at first in- 
creased, and then diminished. Respiratory center is 
depressed. Death by asphyxia or respiratory paralysis. 

7. Uterus. Full doses produce contraction. 

Antagonist — Viburnum. Synergists — Ergot, quinine. 

8. Absorption and Elimination. The drug is rapidly 
absorbed, and is eliminated by the kidneys, bile and 
saliva. 

Untoward Action. Used in the eye may cause pain 
resembling migraine ; internally may produce nausea, 
general uneasiness, or epigastric pain. 

Poisoning. Symptoms, muscular tremors, relaxa- 
tion, reflexes abolished, respiration slow, pupils con- 
tracted, cardiac action depressed, vomiting or purging 1 , 
free sweating, salivation. 



56 NOTES ON MATERIA MEDICA. 

Treatment. Atropine, diffusible heart stimulants, 
tannic acid, stomach pump, external heat. 

Administration. Extract and tincture are most com- 
monly used. Doses at four to six hour intervals. 
Eserine locally in eye. 

Therapeutics. Certain diseases of the eye (i) ; atonic 
constipation, flatulence, gastric and intestinal dilatation 
(2, 3) ; dilatation of the bronchi, bronchial asthma, 
emphysema (2) ; tetanus, chorea, epilepsy (4) ; 
night sweats of phthisis, renal hemorrhage (5). 

Contra Indications. Great debility, arythmical heart 
action, condition of extreme high arterial tension. 

GELSEMIUM. 
Incompatibles — Tannic acid, caustic alkalies. 

1. External Action. Mildly sedative and astringent 
to the skin. 

2. Internal Action. — Digestive Tract. Slightly irri- 
tant to the mucous membrane. 

3. Circulation. Medicinal doses have no marked 
effect; toxic doses render pulse slow and weak, and 
lessen arterial tension. 

4. Nervous System. Cerebrum, no effect. Large 
doses paralyze motor areas of the cord, producing 
paralysis of the muscles. Later cutaneous anesthesia 
is due to paralysis of the sensory tracts of the cord. 
(Action on the nervous system is not definitely set- 
tled.) 

Antagonists — Strychnine, belladonna. Synergists — Phy- 
sostigma, hydrocyanic acid, chloral, etc. 

5. Respiration. Small doses stimulate, quickening 
the action ; large doses depress, respiration becoming 
slow and shallow, and finally paralyzed. 

Antagonists — Strychnine, belladonna. Synergists — Hy- 
drocyanic acid, aconite, etc. 






ANESTHETICS. 57 

6. Temperature. Medicinal doses have no effect, 
poisonous doses reduce the temperature. 

7. Eye. Paralysis of the third nerve (mydriasis and 
ptosis) sometimes of the sixth nerve (strabismus), 
double vision. 

8. Absorption and Elimination. The drug is rapidly 
absorbed, and eliminated by the kidneys. 

Poisoning. Drooping lids, dilated pupils, dimness 
of vision, muscular weakness and incoordination, abol- 
ished reflexes, difficult speech, lowered temperature, 
cold surface, cutaneous anesthesia, reduced pulse and 
respiration ; mind unaffected. Death from respiratory 
or cardiac failure. 

Treatment. Stomach pump, emetics, tannic acid, 
external heat, diffusible stimulants, atropine, artificial 
respiration. 

Untoward Action. Similar to symptoms of poison- 
ing, though milder. 

Administration. Initial dose small, increasing grad- 
ually until dilatation of pupil or drooping of eye-lid is 
evident. Administer every three to six hours. 

Therapeutics. Tetanus, paralysis agitans, tri-facial 
neuralgia, ovarian neuritis, dysmenorrhea (4) ; pruritis, 
eczema (1, 4). 

Contra Indications. Condition of physical weakness 
and weak heart. 



ANESTHETICS. 

AETHER. 



i. External Action. Applied to the skin and allowed 
to evaporate, it is refrigerant, and produces local anes- 
thesia. Confined, it is an irritant and rubefacient, and 
may cause vesication. 



58 NOTES ON MATERIA MEDICA. 

2. Internal Action. Resembles alcohol, but the 
effects are not so lasting. 

Digestive Tract. The drug is an irritant to mucous 
membranes, and may cause spasmodic closure of the 
glottis. It stimulates the secretions of pancreas, sali- 
vary and gastric glands. Increases local circulation, 
carminative. 

Antagonist— Opium. Synergists — Volatile oils, bitters, etc. 

3. Nervous System. At first stimulant, then depres- 
sant ; acts in order on the brain, sensory centers of 
the cord, motor centers of the cord, sensory centers of 
the medulla, and finally motor centers of the medulla ; 
succeeded by respiratory paralysis. 

Antagonists — Strychnine, belladonna, caffeine, etc. Syn- 
ergists — Chloroform, etc. 

4. Circulation. Acts, at first, by reflex action, and 
later directly as diffusible, rapid, but fleeting stimulant 
to heart (increasing pulse and heart force), and to 
vasomotor centers (increasing arterial tension). 
Overdose is a cardiac depressant. It decreases hemo- 
globin and red blood cells. 

Antagonists — Aconite, veratrum, chloroform, etc. Syn- 
ergists — Alcohol, ammonia, strychnine, digitalis, belladonna, 
etc. 

5. Respiration. Arrested at first by reflex spasm 
due to local irritation. It stimulates the respiratory 
action in medicinal doses ; large doses depress. 

Antagonists — Hydrocyanic acid, chloral, etc. Synergists — 
Belladonna, strychnine, caffeine, etc. 

6. Temperature. Is lowered markedly, partially by 
depression of the circulation and respiration, chiefly 
by the chilling of the lungs and evaporation. 

7. Absorption and Elimination. Both are rapid. It 
is eliminated chiefly by the lungs, also by the kidneys, 
which are often irritated by the drug. 



ANESTHETICS. 59 

Administration. When given by the mouth the drug 
should be well diluted with ice-eold water to prevent 
irritation of the passages. Administered by inhalation, 
air should be excluded, but this should be done grad- 
ually, in order to accustom the patient to the drug, and 
so prevent reflex spasm of the glottis. 

Precautions. Smear the face with vaseline to pre- 
vent irritation, never administer on full stomach, 
remove artificial teeth and tobacco, have clothing loose 
about the neck and chest, use only official ether, do 
not give when actual cautery is to be used, avoid ex- 
posure, and protect body heat, never give to young 
women except in the presence of witnesses. Death 
is caused by respiratory failure, hence watch for cyano- 
sis, and remember that general anesthesia is a dan- 
gerous state, therefore do not leave the patient. Watch 
the diaphragmatic function as shown by the movement 
of the abdominal walls. This is the part in which the 
respiratory functions first fail in ether poisoning and 
cessation of action here should occasion the immediate 
withdrawal of the drug. 

General Anesthesia. At first restlessness followed 
by quiet, with slow, full breathing, and quick, strong 
pulse, then follows emotional excitement, with flushed 
face, distended veins in the neck. This is followed by 
the stage of anesthesia in which there is a loss of 
sensation, unconsciousness, abolished reflexes, relaxed 
muscles, contracted pupils (later dilating), respiration 
at first slow and deep, later weak. 

Treatment of Accidents. When cardiac failure 
threatens (face pale), lower the head; flushed cya- 
nosed face indicates respiratory, not cardiac failure. 
When respiration ceases early from mechanical ob- 
struction, ether may" be used hypodermically to stimu- 
late reflexly, but never when respiratory cessation is 






6o NOTES ON MATERIA MEDICA. 



due to poisoning by the drug. Ether may be used 
externally on the chest at any time instead of water, 
as it does not wet the clothes. Alcohol must not be 
used, as its action is too closely allied to that of ether. 
Rhythmical traction on the tongue eleven to fourteen 
times per minute may stimulate diaphragmatic action. 
Use strychnine, digitalis, external heat, artificial respi- 
ration, forcible dilatation of rectum. 

After Effects. Nausea, vomiting, bronchitis, anuria, 
nephritis. 

Therapeutics. Pruritus, urticaria and other skin 
diseases, neuralgia, sciatica (i) ; shock (4) ; surgical 
examinations and operations, obstetrics (3) ; gastralgia, 
flatulent colic (2) ; hysteria, restlessness, insomnia, 
nausea, hiccough (3) ; palpitation of the heart, angina 
pectoris (3, 4) ; tape worm. 

Contra Indications. Diseases of the kidneys and of 
the lungs, dilated or fatty heart, brain tumors, athe- 
romatous arteries, enlarged tonsils, chronic alcoholism, 
aneurism. 

CHLOROFORM. 

1. External Action. It is an irritant to the skin, even 
during evaporation ; confined, it Avill cause vesication, 
and if applied to very sensitive areas of the body may 
cause pain. The drug is not so irritant to mucous 
membranes as ether when inhaled (mixed with air). 

Antagonists — Emollients. Synergists — Irritants. 

2. Internal Action. — Digestive Tract. Like ether, 
but very irritant if concentrated. 

Antagonist — Opium, Synergists — Volatile oils, bitters, 
etc. 

3. Nervous System. Like ether. Death usually due 
to vasomotor paralysis. 

Antagonists— Strychnine, belladonna, caffeine. Syner- 
gists — Ether, etc. 



ANESTHETICS. 6l 

4. Respiration. Like ether, but effects are more 

rapid. 

A ntagonists— Hydrocyanic acid, chloral, etc. Syner- 
gists — Belladonna, strychnine, caffeine. 

5. Circulation. No effect on the blood. Depressant 
to the heart muscle and vasomotor center. Death due 
to vasomotor paralysis, producing anemia of the vital 
centers in the medulla. 

Antagonists — Belladonna, strychnine, digitalis, ergot, etc. 
Synergists — Nitrites, aconite, etc. 

6. Temperature. Is lowered by lessened heat pro- 
duction and increased heat elimination. 

7. Absorption and Elimination. Both are rapid. 
The drug is eliminated by the lungs and kidneys, and 
while sometimes irritating the kidneys, it is much less 
irritant than ether. 

Administration. Given internally the drug must be 
well diluted, administered by inhalation it must be 
well mixed with air, the cone being held away from 
the face. The rate and depth of respiration will be an 
indication of the amount of the drug utilized. There 
is no immunity by frequent repetitions of chloroform. 

Precautions. Like those for ether, except that chlo- 
roform, being non-inflammable, may be used with an 
actual cautery. Watch pulse, particularly the tension, 
and the respiration, which early shows alteration in 
local circulation about the vital center. 

General Anesthesia. No spasms as in ether. There 
may be excitement at first as in ether, though often it 
is absent. Respiration and circulation at first strong, 
then consciousness and sensation become obliterated, 
and if the drug is pushed, utter abolition of reflexes, 
and complete muscular relaxation occur, with sterto- 
rous breathing or rapid, shallow respiration ; weak 



62 NOTES ON MATERIA MEDICA. 

heart. The pupils are contracted during anesthesia ; 
sudden dilatation is a danger signal. Loss of corneal 
reflexes indicates, usually, full anesthesia. 

Accidents. Where idiosyncrasy exists for chloro- 
form, sudden death may occur early in the adminis- 
tration. Cessation of breathing early in the adminis- 
tration is usually due to too great concentration of the 
drug, or to mechanical interference by the tongue. 

Treatment of Poisoning. Draw tongue forward, 
lower the head, bandage the limbs, compress the abdo- 
men, external heat, strychnine, brandy, ether, faradiza- 
tion, artificial respiration, strong coffee by the rectum, 
forcible dilatation of the rectum, compression of the 
testicle, but never give amyl nitrite. 

After Effects. Nausea, vomiting, though not so 
great as from ether; nephritis sometimes. 

Action compared with that of Ether. More depres- 
sant to the vital functions, less irritating to mucous 
membranes, non-inflammable, more agreeable, more 
rapid, more profound narcosis, less vomiting, less ex- 
citant ; must be well diluted with air. Chloroform 
mortality, one in 3,000; ether mortality, one in 6,000. 
Chloroform is to be preferred in hot countries, in multi- 
anesthesia, in conditions which contraindicate ether, 
in brain surgery and operations on the mouth, in ob- 
stetrics, and with children. The danger from chloro- 
form is due more to the methods of administration 
than to the properties of drug itself. 

Therapeutics. Neuralgia, rheumatism (1) ; colic 

(2) ; surgical examinations and operations, obstetrics 

(3) ; irritative cough (3, 7) ; bronchitis (1). 

Contra Indications. Fatty heart, valvular heart dis- 
ease. 



DEPRESSANTS OF CIRCULATORY SYSTEM. 63 

NITROUS OXIDE. 

The drug is a safe, but fleeting anesthetic, devoid of 
irritating effects, when pure. 

Administration. By inhalation from a tube, air be- 
ing excluded. 

General Anesthesia. The face is at first flushed, and 
then grows pale, and the jaw drops. The pulse is 
strong and quick, and the arterial tension is raised, 
followed later by a fall. Respiration shallow and 
frequent. Anesthesia is produced partially by the les- 
sened supply of oxygen and by direct effect on the 
brain. Anesthesia is prompt, being produced usually 
in about one minute, and lasting about from three to 
four minutes. Its use is attended by no after effects 
except occasional giddiness. If depression occurs, 
withdrawal of the drug and administration of oxygen 
will relieve the condition. There is some tendency 
towards motor stimulation, which in children and 
anemic persons may cause jactitation. 

Therapeutics. Minor surgery and dentistry. 

Contra Indications. Old age, or atheroma, on ac- 
count of sudden rise in arterial tension, idiosyncrasy, 
large tonsils, lung or heart disease. 



DEPRESSANTS OF CIRCULATORY SYSTEM. 

ACONITE. 

1. External Action. At first stimulant to sensory 
nerve terminals, causing tingling, then depressant pro- 
ducing anesthesia and numbness. 

Antagonists — Irritants. Synergists — Relladonna, cocaine, 
etc. 

2. Internal Action. — Digestive Tract. At first irri- 
tant to mucous membranes, causing tingling, and 



64 NOTES ON MATERIA MEDICA. 

increasing secretion. Anesthetic. No other effect on 
the stomach unless the dose is large, when vomiting 
may result. 

Antagonists — Cerium oxalate, bismuth, etc. Synergists — 
Irritants. 

3. Nervous System. No effect on the intellectual 
centers of the brain. It is depressant to peripheral 
sensory nerves, then to sensory side of the cord, re- 
flexes diminished. Large doses paralyze motor centers 
in the cord and motor nerve terminals. 

Antagonists — Strychnine, caffeine, belladonna, etc. Syn- 
ergists — Opium, bromide, acetanilid, etc. 

4. Circulation. The chief effect of moderate doses is 
a slowing of the heart, due to stimulation of the inhibi- 
tory centers. Larger doses cause depression of the 
muscle fiber, hence weak and irregular heart action, 
and also of the peripheral ends of the vagus. The 
heart is arrested in diastole. Arterial tension. This 
is lessened by decreased cardiac action, and it is further 
depressed by reflex dilatation of blood vessels, due to 
the primary stimulation of the afferent nerves in the 
skin. Moderate doses produce stimulation of the vaso- 
motor center, but large doses depress the center. 

Antagonists — Digitalis, ergot, belladonna, strychnine, alco- 
hol. Synergists — Veratrum, antimony. 

5. Respiration. Quieted, if breathing is hurried. 
Large doses depress the afferent nerve terminals in 
the lungs and the respiratory center ; also weakens 
muscles of respiration, and causes veinous congestion 
by interference with the circulation. 

Antagonists — Belladonna, strychnine. Synergists — Anti- 
mony, hydrocyanic acid, etc. 

6. Temperature. Is lowered, by diminished meta- 
bolism, through retarded circulation, and by dilatation 



DEPRESSANTS OF CIRCULATORY SYSTEM. 65 

of the cutaneous blood vessels, and by depression of 
muscular tissue. 

7. Absorption and Elimination. The drug is quickly 
absorbed, and its effects last from three to four hours. 
It is probably eliminated by the skin and the kidneys, 
acting as a diuretic and diaphoretic. 

Untoward Action. Intense itching, vesicular and 
even pustular eruptions, vertigo, diminution of vision. 

Poisoning. Symptoms. Tingling and burning sen- 
sation of the mucous membranes, beginning with the 
lips, vomiting, numbness, pulse weak and slow, then 
rapid and trickling, sweating, slow and shallow respira- 
tion, face pallid and anxious, exophthalmos, anesthesia 
of the skin, pupils variable, unusually dilated, tempera- 
ture low, sometimes epileptiform convulsions, con- 
sciousness preserved. Death by gradual or sudden 
respiratory paralysis. 

Treatment. Head lower than the heels, external 
heat, emetics or stomach pump, ether, alcohol, digitalis, 
atropine, strychnine, artificial respiration. 

Administration. The tincture is the best prepara- 
tion. Very minute doses frequently repeated (say one- 
tenth to one-half a minim every fifteen minutes to one 
hour) give good results. 

Therapeutics. Neuralgia, neuritis, herpes, chil- 
blains, pruritus, chronic rheumatism (1) ; sthenic 
fevers, tonsillitis, laryngitis, etc., bronchitis, the first 
stage of pneumonia and pleurisy (4, 6) ; pericarditis, 
nervous palpitation, excessive hypertrophy (4) ; colds 
(4, 7) ; cerebro-spinal meningitis, aneurism (4) ; vom- 
iting of pregnancy, migraine, hyperesthesia (3). 

Contra Indications. Sub-acute and chronic diseases, 
weak heart, gastric catarrh 



66 NOTES ON MATERIA MEDICA. 

VERATUM VIRIDE. 

This is a safer drug than aconite, and its action 
resembles that of aconite, except in the following par- 
ticulars : 

External Action. It is more irritant to the skin. 

Internal Action. — Digestive Tract. It is more irri- 
tant to mucous membranes. 

Circulation. It is more depressant. 

Nervous System. It has little or no effect on the 
sensory nerves, but depresses striated muscle, and 
finally paralyzes the motor tracts. 

Respiration. It is less depressant. 

Absorption and Elimination. It is quickly absorbed, 
and is eliminated by the bowels. It is less diuretic 
than aconite, and also less diaphoretic. 

Poisoning. Symptoms. Causes no anesthesia of the 
skin. 

Therapeutics. Not used externally. Internally, like 
aconite. 

AMYL NITRITE. 

1. External Action. None of consequence. 

2. Internal Action. — Circulation. The drug pro- 
duces great vascular dilatation by depression or 
paralysis of the muscular coat of the blood vessels. 
The heart acts tumultuously through relaxed inhibition 
and lessened resistance in the blood-vessels. Hemo- 
globin is changed to methemoglobin. 

Antagonists — Belladonna, strychnine, ergot, digitalis. 
Synergists — Aconite, veratrum, chloroform. 

3. Respiration. Quickened by depression of the 
respiratory muscles and the condition of the blood. 

4. Nervous System. Reflexes and motility are les- 






DEPRESSANTS OF CIRCULATORY SYSTEM. 67 

sened by depression of the motor areas of the brain 
and cord. Sensation is diminished. 

Antagonists — Strychnine, caffeine, coca. Synergists — 
Chloral, bromides, opium. 

5. Temperature. Lowered by reason of the dilata- 
tion of cutaneous vessels and diminished oxygen- 
carrying power of the red blood corpuscles. 

6. Eye. Dilatation of the retinal blood vessels, 
causing color and visual hallucinations. 

7. Absorption and Elimination. It is very rapidly 
absorbed, more so by inhalation than when adminis- 
tered by the mouth ; the effects are correspondingly 
transitory. Elimination by the kidneys is very rapid, 
increasing urine, uric acid and urea, and occasionally 
causing the appearance of sugar. 

Untoward Action. Pharyngeal and gastric irritation, 
dryness of mouth, subjective sensations of color 
(usually yellow), flushed face, sensation of heat, throb- 
bing in head, frontal headache. 

Poisoning. Symptoms. Rapid, weak heart, cyano- 
sis, slow and shallow respiration, cold extremities, 
subnormal temperature, abolished reflexes. Frontal 
headache is very intense. Death from cardiac or 
respiratory failure. 

Treatment. Strychnine, digitalis, ergot, atropine, 
diffusible stimulants, artificial respiration. 

Administration. Given usually only in emergency. 
Administered by inhalation until flushing in the face 
occurs ; to be repeated according to indications. 

Therapeutics. Angina pectoris (2) ; epilepsy, 
asthma, cardiac dyspnea, puerperal eclampsia, tetanus, 
strychnine poisoning, hiccough (4) ; congestive chill, 
chronic nephritis, chronic dysmenorrhea, enlarged 
heart, arterio-sclerosis (2). 

Contra Indications. Conditions of physical debility. 



68 NOTES ON MATERIA MEDICA. 

NITROGLYCERIN. 

The action of this drug is in every respect similar 
to that of amyl nitrite, except that its effects are 
produced more slowly and are more lasting, and that 
it causes more severe frontal headache. 

Administration. Hypodermically or by the mouth 
every three to six hours. 

SODIUM NITRITE. 

Similar to nitroglycerin, except that its action is 
more slowly attained and of longer duration. 

Administration. Every four to six hours by mouth. 



DEPRESSANTS OF RESPIRATORY SYSTEM. 

HYDROCYANIC ACID. 

Incompatiblcs — Cobalt nitrate, metallic salts. 
This is perhaps the most rapidly acting poison 
known. 

i. External Action. Applied to the skin, it paralyzes 
the end organs of the sensory nerves. 

Antagonists — Irritants. Synergists — Aconite, belladonna. 

2. Internal Action. Locally, in the stomach it pro- 
duces depression of the sensory nerve terminals. 

Antagonists — Irritants. Synergists — Aconite, cocaine, car- 
bolic acid, etc. 

3. Respiration. Respiratory action is depressed by 
medicinal doses. Nerve terminals in the lungs are 
depressed. 

Antagonists — Belladonna, strychnine, caffeine, ammonia, 
camphor. Synergists — Aconite, bromides, opium, etc. 

4. Circulation. At first the heart is slowed by stimu- 
lation of the pneumogastric nerve, and arterial tension 



DEPRESSANTS OF RESPIRATORY SYSTEM. 69 

is raised by stimulation of the vasomotor center. This 
is soon followed by depression. 

Antagonists — Strychnine, ammonia, ether, etc. Syner- 
gists — Aconite, nitrites, etc. 

5. Nervous System. Medullary centers, peripheral 
afferent nerves, cord, motor nerves, and muscles are 
depressed ; convulsions which occur are due to cerebral 
circulatory changes. Death is caused by paralysis of 
the respiratory or cardiac centers. 

Antagonists — Strychnine, caffeine, cocaine. Synergists — 
Chloral, bromides, chloroform, etc. 

6. Absorption and Elimination. The drug is rapidly 
absorbed and very rapidly eliminated by all avenues, or 
changed in the body (absorption may take place 
through broken skin). 

Untoward Action. Salivation, irritation of the 
throat, headache, palpitation, staggering gait, drowsi- 
ness. 

Poisoning. May be sudden or gradual. When sud- 
den, the patient falls and expires with a gasp or 
convulsive movement. If gradual, the symptoms are 
burning in the throat, nausea and vomiting, dyspnea, 
slow, full pulse, giddiness, muscular weakness, dilated 
pupils, muscular spasm, incontinence of urine and 
feces. 

Treatment. Ammonia, ammonium carbonate, whis- 
key and other cardiac stimulants, atropine, strychnine, 
cobalt nitrate, alternate hot and cold spinal douches 
and artificial respiration. 

Administration. Only the diluted acid is used, a 
whiff of the strong acid being sufficient to produce 
death. Because of the fleeting action of the drug, it 
must be administered at short intervals to maintain its 
effect, say every half hour to every two hours. 



jo NOTES ON MATERIA MEDICA. 

Therapeutics. Gastralgia, vomiting (2) ; pruritus, 
certain skin diseases (1) ; irritable cough, asthma, 
whooping-cough (3). 

Contra Indications. Conditions of extreme debility. 



RESTORATIVES. 

THE GLYCEROPHOSPHATES. 

These preparations nearly approach the form in 
which phosphorus naturally occurs in the nervous 
tissues. They sometimes mildly stimulate the nervous 
system, but usually their effects are slowly produced. 
Their principle action is that of a nerve tonic or food, 
and from this action proceeds its beneficent effect in 
the different conditions in which they are used. 

Administration. Sodium glycero-phosphate in solu- 
tion. Calcium, lithium and iron salts in capsules. 

Therapeutics. Neurasthenia, hysteria, nervous dys- 
pepsia, chronic alcoholism, and any condition in which 
lack of nerve nutrition is present. 

MINERAL ACIDS. 

Incompatible s — Alkalies and their carbonates, salts of 
lime, lead and silver, oxidizable substances with hydro- 
chloric acid, 
i. External Action. The strong acids are escharotic, 
abstracting water from the tissues, and combining with 
the albumin of the body, destroying the protoplasm, 
and forming an eschar. Very dilute, they are irritant 
and astringent. 

Antagonists — Alkalies, emollients. Synergists — Irritants. 

2. Internal Action. — Digestive Tract. In the mouth 
they have an acid taste, and by their astringency pro- 
duce a feeling of roughness. They stimulate the sali- 
vary secretion. In the stomach they are supposed to 



RESTORATIVES. 71 

lessen secretion, and to act as antiseptics, checking 
fermentation. In the intestines they tend to constipate 
by their astringency. Digestive processes are thus 
improved, but if too long continued digestion is inter- 
fered with. 

Antagonists — Alkalies, opium. Synergists — Digestants, 
strychnine, astringents. 

3. Circulation. The alkalinity of the blood is les- 
sened, and if long continued, the quality of the blood 
deteriorates. Heart action is quickened, and arterial 
tension is moderately raised through nervous stimula- 
tion. Concentrated acids relax the heart muscle and 
blood vessels. 

4. Nervous System. They stimulate the brain 
slightly. 

5. Absorption and Elimination. They are rapidly 
absorbed. In the intestines they are converted into 
neutral salts, and so absorbed ; entering the blood, they 
combine with the alkaline bases. They are rapidly 
eliminated by the kidneys as acid salts, rendering the 
urine more acid. 

Untoward Action. Too long continued, tender 
mouth, salivation, pain, diarrhea, anemia, loss of flesh. 

Poisoning. These drugs are corrosive poisons, de- 
stroying the mucous membranes of the mouth and 
stomach. Symptoms. Burning pain, strong acid taste, 
swollen tongue, discolored lips, vomiting (blood), 
purging, temperature may be elevated at first, collapse. 
Death by shock or exhaustion. If death does not occur 
soon, fatty degeneration of the vital organs develops. 

Treatment. Demulcent drinks, soap or flour and 
water, egg albumin, milk, oil, carbonates cautiously, 
stomach pump cautiously, opium, stimulants. 

Administration. Except nitrohydrochloric acid, 
only the diluted acids should be given internally. They 



J2 NOTES ON MATERIA MEDICA. 

should all be well diluted when given, and should be 
given through a tube to protect the teeth, followed by 
an alkaline mouth-wash. Administer after meals. 

Hydrochloric Acid. This is the least powerful acid, 
producing a tan schar, and is diffusible by redissolving 
tissue. 

Sulphuric Acid. This and nitric are the two strong- 
est acids. It produces a black eschar, and is diffusible. 

Nitric Acid is one of the strongest acids, but is 
limited in its caustic action. It is hot diffusible. If it 
is too long continued, it may produce salivation. 

Nitrohydrochloric Acid. This is a powerful acid, 
even dissolving gold and platinum. The best effects 
are obtained by using the strong acid freshly prepared 
and well diluted at the time of administration. It has 
a special action as a liver stimulant by both internal 
and external use. 

Phosphoric Acid. This acid is supposed to have 
special effect upon the nervous system. 

Therapeutics. — Hydrochloric Acid. Noma, diph- 
theria, obstetrics, caries (i) ; gastric dyspepsia, intes- 
tinal indigestion, fevers, certain skin diseases (2). 

Sulphuric Acid. Chancroid, cancer, bites of animals 
(1) ; serous diarrhea, cholera, lead poisoning, hema- 
temesis, intestinal and uterine hemorrhage (2) ; sweat- 
ing, scurvy, certain itching skin diseases (3). 

Nitric Acid. Cancer, warts, gangrene, phagedenic 
ulceration, hemorrhoids, prolapse of the rectum, certain 
nose and throat diseases, moles, nerve and other skin 
diseases (1) ; intermittent fevers, serous diarrhea (2). 

Nitrohydrochloric Acid. Hepatic disorders, syphilis, 
oxaluria, lithemia (3). 

Phosphoric Acid. Tuberculous glands, scrofulous 



RESTORATIVES. 73 

ulcers (1), anemia, wasting diseases, neurasthenia, 
diabetes (3, 4). 

Contra Indications. Acute inflammation of the 
stomach, rheumatism, gout, excessive acidity of urine. 

VEGETABLE ACIDS. (Acetic, Citric, Tartaric.) 

Incompatibles — Alkalies. 

1. External Action. Irritant and, except glacial 
acetic acid, not caustic like mineral acids, acetic being 
the strongest and citric being the weakest. 

2. Internal Action. — Digestive Tract. Similar to 
mineral acids. Intestinal glands are more stimulated 
than by mineral acids. The rest of the action is similar 
to that of mineral acids, but milder. 

Therapeutics. — Acetic Acid. Obstetrics, gonorrhea, 
warts, corns, parasitic skin diseases, epistaxis (1). 

Citric Acid. Urticaria, sweating (1) ; catarrhal 
jaundice, malaria, acute rheumatism (2). 

Tartaric Acid. Diphtheria (1). 

Contra Indications. As for mineral acids. 

THE ALKALIES. 

Liquor potassae, potassii acetas, potassii bicarbonas, 
potassii carbonas, potassii citras, potassii tartras, liquor 
sodae, sodii acetas, sodii bicarbonas, sodii carbonas, 
calcii carbonas precipitata, creta preparata, liquor 
calcis, lithii carbonas, lithii citras, magnesia, ammonii 
carbonas. 

Direct Antacids. Lime water, prepared chalk and 
magnesia. 

Indirect Antacids. Potassium acetate, tartrate, bi- 
tartrate, citrate, sodium acetate, lithium citrate. 

Both Direct and Indirect Antacids. Liquor potassae, 



74 NOTES ON MATERIA MEDICA. 

liquor sodae, the carbonates and the bicarbonates of 
potassium, sodium, lithium, ammonium and magne- 
sium. 

Incompatibles — Acids, metallic salts. 

1. External Action. Liquor potassae and liquor 
sodae are caustic, rubifacient, and soften and dissolve 
the epidermis, and also combine with albumin. Car- 
bonates and bicarbonates are similar, but far less 
powerful in their action. Ammonium salts penetrate 
without dissolving the cuticle, cause effusion of lymph 
(vesicant), and if confined will cause suppuration and 
sloughing. 

2. Internal Action. — Digestive Tract. Small doses 
of potassium increase the gastric flow when given be- 
fore meals. Given after meals or in large doses, it 
neutralizes the gastric juice, and therefore interferes 
with gastric and intestinal digestion. 

Antagonists — Belladonna, etc. Synergists — Bitters, strych- 
nine, etc. 

3. Circulation. Potassium salts increase the alka- 
linity of the blood, except the bicarbonate, when given 
on an empty stomach. Given after meats, these salts 
decompose in the stomach, and the alkaline base in- 
creases the alkalinity of the blood. Acetates, citrates 
and tartrates are changed in the blood into carbonates, 
and increase its alkalinity. 

The hemoglobin is increased by potassium, but large 
amounts lessen its ozonizing function. Poisonous or 
long continued doses depress the heart muscle, weaken- 
ing its force. Small doses increase the blood pressure ; 
minute doses increase the contractile power of muscle ; 
large doses depress and paralyze. 

Antagonists — Acids, cardiac stimulants. Synergists — 
Mercury, iodine, etc. 



RESTORATIVES. 75 

4. Nervous System. Excessive doses paralyze nerve 
centers and motor nerves. 

Antagonists — Strychnine, caffeine, etc. 

5. Respiration. Bronchial secretions are increased 
in quantity, and are rendered more fluid. 

Antagonists — Belladonna, opium, etc. Synergists — Ex- 
pectorants. 

6. Absorption and Elimination. They are quickly 
absorbed and eliminated. Salts of the vegetable acids 
are eliminated as carbonates, rendering the urine alka- 
line. Potassium salts are eliminated by the kidneys 
and bronchi, acting as diuretics and expectorants. 
Both the water and the solid matter of the urine are 
increased, urea is also increased, uric acid is dimin- 
ished. The drug promotes waste. 

Untoward Action. Impaired digestion, paralysis of 
the muscle fibers of the intestines, emaciation, anemia, 
nervous prostration, muscular weakness. 

Poisoning. Caustic preparations are corrosive 
poisons. 

Treatment. Vegetable acids, oils, demulcent drinks, 
stimulants, etc. 

Administration. Give always well diluted, whether 
before or after meals depends upon the effects desired. 

COMPARISON OF THE OTHER ALKALIES WITH 
POTASSIUM. 

Sodium Salts. Are less depressant, less quickly ab- 
sorbed, less diuretic, less solvent of uric acid. 

Calcium Salts. They are direct antacids, and are 
more sedative and astringent to the digestive tract. 
They tend to constipate, have less effect on muscles 
and the reaction of the urine, and are less readily ab- 
sorbed and eliminated. Avoid in oxaluria. 



76 NOTES ON MATERIA MEDICA. 

Magnesium Salts. They are direct antacids and 
gastric sedatives. Are also saline cathartics, and have 
less effect on the blood and heart, and are also less 
readily absorbed and eliminated. 

Ammonium Salts. Are antacid and dilate the gastric 
vessels. See "Ammonium." 

Therapeutics. — Liquor Potassae. Ingrowing toe 
nail, certain diseases of the skin, ear, and throat. 

Carbonates and Bicarbonates. Certain diseases of 
the skin, burns, painful joints in acute rheumatism, 
certain diseases of the ear and throat (i) ; deficient 
gastric juice, hyperacidity of the stomach, atonic dys- 
pepsia (2) ; gout, acute rheumatism, chronic rheuma- 
tism, rheumatoid arthritis (3). 

Prepared Chalk. Certain diseases of the skin, burns, 
leucorrhea, vaginitis (1) ; diarrhea in children (2). 

Acetates, Bitartrates and Citrates. They are used as 
diuretics, cathartics and diaphoretics, in lithemia, uric 
acid calculi, chronic and acute nephritis, cardiac dropsy 

(2, 6). 

Lime Water. Acid stomach, vomiting, arsenical 
poisoning (2) ; diabetes insipidus, chronic bronchitis 
(6). 

Contra Indications. Phosphatic diathesis, calcium in 
oxaluria. 



ALTERATIVES. 

ARSENUM. 

Incompatibles — Salts of iron, silver, magnesia, lime, cop- 
per, ammonium and vegetable astringents. 

I. External Action. On the skin it is caustic and 
escharotic, followed by sloughing. It may be absorbed 
from the broken skin. 

Antagonists — Emollients. Synergists — Caustics. 



ALTERATIVES. 77 

2. Internal Action. — Digestive Tract. Irritant to 
mucous membranes. In the stomach small doses stim- 
ulate secretion and peristalsis. In large doses it is a 
violent irritant. The drug has similar action in the 
intestines. 

Antagonists — Astringents, etc. Synergists — Bitters, etc. 

3. Nervous System. Small doses are tonic to the 
brain and entire nervous system (antiperiodic), espe- 
cially to trophic nerves, stimulating nutritive changes. 
Large doses depress first the sensory cord, diminishing 
reflexes (tingling, hyperesthesia, anesthesia), then fol- 
lows depression of the motor cord and paralysis, 
especially of the extensors. The drug tends to accu- 
mulate in nerve tissue, and is often found in nerve 
centers. 

4. Circulation. On the blood the drug acts as a 
hematic, small doses preventing destruction of red 
blood cells and aiding iron. Large doses decrease the 
red blood cells and lessen the coagulability of the 
blood. Small doses stimulate the heart, increasing the 
rate and force ; large doses directly depress the muscle, 
ganglia and nerves, rendering the action irritable and 
feeble. Arterial tension is lowered by depression of 
the heart and vasomotor system. The larger vessels 
are especially relaxed. 

5. Respiration. Small doses distinctly stimulate the 
respiratory center, and possibly the lung terminals of 
the vagus. Large doses depress. 

6. Metabolism. Is decreased by small doses and in- 
creased by large doses. The drug is an alterative. 

7. Absorption and Elimination. The drug is readily 
absorbed. It is eliminated by the kidneys (increasing 
the urine in small doses, decreasing it in toxic doses) ; 
skin (exfoliation and eruption) ; bowels (purging) ; 
saliva ; milk (may effect nursing child) ; bronchi. 



78 NOTES ON MATERIA MEDICA. 

Eye. Large or continued doses may cause injection 
of the conjunctiva, inflammation and edema of the lids, 
and neuritis. 

Untoward Action. Restlessness, headache, alopecia, 
bronchitis, coryza, thirst, digestive disturbances, puffy 
lids, cutaneous eruptions. 

Poisoning. — Acute. Symptoms. Symptoms of acute 
gastro-enteritis with "rice water" stools with blood and 
shreds of mucous membrane. Often a remission about 
the third day, as in phosphorus poisoning. Thirst, 
albuminous urine, rash, multiple neuritis may occur. 
Death in from four to six days. Occasionally death 
may occur quickly after the injection of the poison 
with collapse. If the patient lives long, fatty degenera- 
tion of the organs will take place. 

Treatment. Stomach pump, emetics, cardiac stimu- 
lants, demulcent drinks, hydrated sesquioxide of iron 
and magnesia, lime water, dialyzed iron, magnesia. 

Poisoning. — Chronic. Symptoms. Headache, vom- 
iting, diarrhea, abdominal pain, irritation of the 
respiratory tract, watery eyes, injected conjunctiva, 
herpes zoster, peripheral neuritis, paralysis of extensor 
muscles, depression. 

Treatment. Potassium iodide, tonics, hygiene. 

Administration. The drug is usually given three 
times a day after meals. Arsenous acid is the solid 
preparation most used, and solution of potassium 
arsenite (Fowler's Solution) the liquid. Children bear 
arsenic well. Begin with minute dose and increase 
gradually up to ten or fifteen minims, or until untoward 
symptoms appear. If the drug is administered hypo- 
dermically, it is less toxic than when given by the 
mouth. For this purpose sodium arsenite is best, as 
Fowler's solution is irritating, and may cause abscess. 
By careful use tolerance may be established. 



ALTERATIVES. 79 

Therapeutics. Superficial cancer, sarcoma, warts, 
corns (1) ; numerous chronic skin diseases, asthma, 
bronchitis (7) ; dysmenorrhea, pernicious anemia, 
leukemia, Hodgkin's disease (4) ; malaria, neuralgias, 
headache (3) ; phthisis, with excessive expectoration 
(3, 4, 6) ; chorea (3) ; gastralgia, gastritis, gastric 
ulcer, cancer, constipation (2) ; syphilis (6) ; hay fever, 
coryza (3, 7) ; melancholia, hypochondria (3, 4). 

Contra Indications. Acute skin diseases, intestinal 
inflammation, acute phthisis, with tendency to hemor- 
rhage. 

HYDRARGYRUM. 

Incompatibles are so general that this drug is best admin- 
istered alone. 

1. External Action. Metallic and mercurous prepa- 
rations are absorbed. They do not combine with 
albumin. Metallic preparations are non-irritant. Mer- 
curous preparations are stimulant or slightly irritant. 
Mercuric preparations are irritant, combine with 
albumin, and are not absorbed. All preparations of 
mercury are antiseptic and anti-parasitic. Mercuric 
preparations are most antiseptic. 

2. Internal Action. — Digestive Tract. Mercury in 
the stomach forms a molecule of chlorine, sodium, mer- 
cury and albumin, which is partly absorbed here. 
Mercuric preparations, if concentrated, will cause 
gastro-enteritis. Mercurous preparations are not irri- 
tant to the stomach. In the intestines, mercury stimu- 
lates the secretions of the intestinal glands and of the 
pancreas, causes expulsion of the bile from the gall- 
bladder, and increases peristalsis, its action being 
chiefly on the duodeneum and jejunum. In causing the 
outflow of the bile, it acts as an indirect cholagogue. 
The bichloride is supposed to stimulate the liver 



80 NOTES ON MATERIA MEDICA. 

directly. Mercury is absorbed in part only in the 
intestines, the rest passing out as the sulphide. 

Antagonists — Opium, belladonna, astringents. Syner- 
gists — Cathartics, intestinal antiseptics. 

3. Blood. The drug is readily absorbed, forming 
oxyalbuminate. In small doses it acts as a tonic to the 
blood, increasing the number of the red blood corpus- 
cles. In large doses, or too long continued, it reduces 
the ozonizing function of the blood, and also lessens its 
coagulability by diminishing the fibrin factors. The 
blood becomes watery, and anemia is produced. 

Antagonists (for large doses) — Hematics. 

4. Respiration, Circulation, Nervous System. All 
are depressed by prolonged use. 

5. Special Action. The drug is an alterative, pro- 
ducing change in the growth of cells. In small doses 
it is stimulant to the tissues, but large doses impair 
nutrition. All secretions are increased by mercury. 

Antagonists — Opium, belladonna. 

6. Absorption and Elimination. It is eliminated by 
all avenues, but nevertheless the drug accumulates 
rapidly in the tissues. 

Untoward Action. Eczema, erythema, salivation, 
stomachic disturbances. 

Mercurial Poisoning. — Acute. Symptoms. Fetid 
breath, swollen, tender and spongy gums, loose teeth, 
profuse salivary flow, metallic taste, anorexia, vomit- 
ing, purging, emaciation, pallor, cutaneous eruptions, 
headache, insomnia, tremor, convulsions, coma. 

Treatment. Stomach tube, white of egg, demulcent 
drinks, potassium chlorate, tannic acid, atropine, 
opium, heart stimulants, nutritious food. 

Poisoning. — Chronic. Symptoms. Cachexia, ane- 
mia, emaciation, leathery skin, anorexia, nausea, ten- 



ALTERATIVES. 8l 

dency to diarrhea, pulse rapid on exertion, respiration 
labored, paralysis of groups of muscles, muscular 
weakness. Special senses are all diminished, mental 
weakness, irritability and depression, alopecia. 

Treatment. Magnesium sulphate, remove cause, sul- 
phur internally and in baths, potassium iodide, symp- 
tomatic. 

Administration. Idiosyncrasy is common. Avoid if 
patient has been previously salivated. Use cautiously 
in depressed conditions. Externally use the ointment 
by inunction. The oleate is simply applied to the skin. 
Calomel locally or by fumigation. Inunction should be 
used on thoroughly cleaned surfaces, and where the 
skin is thin. Fumigation under blankets draped from 
the neck down. The drug may be given hypodermi- 
cally deep into the gluteal muscles or subcutaneously 
into the back, the bichloride being generally used for 
this purpose. Internally, calomel, blue powder and 
the bichloride may be used for effects on the alimen- 
tary tract. All preparations may be used for systemic 
effects. 

Therapeutics. Diseases of the skin, venereal ulcers, 
many diseases of the eye, ear and throat, sub-acute 
synovitis, syphilitic orchitis and epidydimitis, skin 
parasites (i) ; syphilis (5) ; chronic dysentery and diar- 
rhea of children, vomiting, hepatic congestion, cirrho- 
sis, bilious attacks (2) ; non-suppurative inflammation, 
chronic interstitial nephritis, chronic endarteritis, etc. 
(5) ; sthenic acute inflammation, meningitis, pericardi- 
tis, acute bronchitis, early in pneumonia, endocarditis, 
diphtheria, membranous croup (3). 

Contra Indications. Tuberculosis, strumous diathe- 
sis, chronic intestitial nephritis when it diminishes the 
urine, acute asthenic diarrhea and dysentery, previous 
salivation. 



82 NOTES ON MATERIA MEDICA. 

IODUM. 

Incompatibles are general. The drug is best administered alone. 

1. External Action. On the skin it is an antiseptic, 
irritant, and may cause vesication and desquamation. 
It stains the skin brown. The fumes irritate the respi- 
ratory tract when inhaled (sneezing, coryza, headache, 
etc.). 

Antagonists — Emollients. Synergists — Irritants. 

2. Internal Action. It has a disagreeable taste, 
causes lacrymation, and is readily absorbed by the 
mucous membrane, forming a loose combination with 
albumin. In the stomach small doses are stimulant, 
large doses are irritant, and may cause inflammation. 
It here forms sodium iodide and sodium iodate, and 
is so absorbed. 

Antagonists — Bismuth, oils, etc. 

3. Alkaline Iodides have no external action ; they 
produce a metallic taste in the mouth, and are irritating 
to the stomach. Iodine and the iodides have no known 
influence on the blood except to lessen the solid con- 
stituents if long continued. 

4. Special Action. They are general alteratives, dis- 
solving the metals out of the tissues, altering nutrition, 
lessening the vitality of the newly formed tissues, and 
absorbing new growths. 

5. Nervous System, Respiration, and Circulation. 
They are all depressed by poisonous doses. 

6. Uterus. Small doses hasten menstrual flow ; large 
doses depress. Continued use may cause atrophy of 
the ovaries. The drug is said to produce abortion. 

7. Absorption and Elimination. The drug is 
promptly absorbed, and is rapidly eliminated by all 
avenues, kidneys (diuretic, nitrogenous waste in- 
creased, nephritis) ; salivary glands (salivation) ; skin 



ALTERATIVES. 83 

(eruptions, antiseptic and stimulating) ; lungs (stimu- 
lating and antiseptic). 

Untoward Action. See "Iodism." 

Poisoning. — Acute. Symptoms. Metallic taste, 
burning in the throat, gastro-enteritis, depression, 
rapid, weak pulse, convulsions, urine dark, scanty and 
albuminous or suppressed. Death by respiratory fail- 
ure. 

Treatment. Stomach pump, starch, sodium bicar- 
bonate, stimulants, external heat. 

Poisoning. — Chronic. Iodism. Symptoms. Frontal 
headache, lacrymation, salivation, expectoration, in- 
creased nasal secretions, acne, anemia, emaciation, 
muscular weakness, palor, dyspnea, numbness, loss of 
intellect, loss of sexual power, atrophy of the mam- 
mary glands and testicles. 

Administration. As all are irritant, protect the 
stomach with milk. The sodium salt is less toxic than 
the potassium. The iodides are best given in small 
doses at first, gradually increasing to establish toler- 
ance. Tincture of belladonna and sodium bicarbonate 
prevent coryza. Syrup of hydriodic acid is not apt to 
cause iodism. 

Therapeutics. Chronic gout, pleurisy, synovitis, 
neuritis, periostitis, onychia, bubo, enlarged glands, 
hydrocele (hypodermically), anal fissure, chronic me- 
tritis and endometritis, various skin diseases, certain 
chronic splenic and hepatic diseases, acute coryza, ca- 
tarrhal deafness, chronic pharyngitis, inflamed joints 
(1) ; syphilis, mercurial poisoning, scrofula (4) ; cir- 
rhosis, tubercular meningitis, dropsy, muscular rheu- 
matism, chronic interstitial nephritis, asthma (4, 5) ; 
vomiting of pregnancy (2). 

Contra Indications. Tuberculosis, administration of 
quinine, iodism. 



84 NOTES ON MATERIA MEDICA. 

COLCHIUM. 

Incompatibles — Tannic acid. 

1. External Action. It is irritant and rubifacient to 
the skin. Inhaled it causes sneezing. 

Antagonists — Emollients. Synergists — Irritants. 

2. Internal Action. — Digestive Tract. Small doses 
increase the flow from all of the glands, especially the 
bile. Larger doses cause burning in the epigastrium, 
nausea and loss of appetite. Toxic doses produce 
gastro-enteritis. 

Antagonists — Opium, belladonna, etc. Synergists — Mer- 
cury, podophyllin, etc. 

3. Circulation. Small doses have no effect. Large 
doses cause weak, rapid pulse. 

Antagonists — Alcohol, opium, etc. Synergists — Cardiac 
depressants, etc. 

4. Nervous System. No effect in small doses. Large 
doses may cause numbness, muscular pain or convul- 
sions. The intellect is unaffected. 

5. Respiration. Is depressed by toxic doses. 

6. Special Action. Alterative, especially in gouty 
diathesis. 

7. Absorption and Elimination. The drug is rapidly 
absorbed, and is eliminated by the bowels, kidneys and 
somewhat by the skin. Urea and uric acid are prob- 
ably increased. 

Poisoning. Symptoms. Intense gastro-enteritis 
with agonizing pain, and treatment is usually unavail- 
ing. 

Treatment. Stomach pump, tannin, emetics and 
bland drinks, cardiac and respiratory stimulants, 
opium. 

Administration. The strength of the crude drug 
varies. Use assayed tincture, and begin with small 



ALTERATIVES. 85 

dose three times a day after meals. When purging 
occurs, the dose should be lessened. 

Therapeutics. Gout, diarrhea, dysentery, dyspep- 
sia, bronchitis, asthma, neuralgia, eczema of gouty 
origin (6) ; ascites, cerebral and portal congestion (2). 

Contra Indications. Acute inflammation of the 
gastro-intestinal tract, care in old age. 

PHOSPHORUS. 

Incompatibles — Hydrated magnesia, lime water, charcoal, 
copper sulphate. 

1. External Action. Applied to the skin it causes 
inflammation and sometimes gangrene. Inhalation of 
the fumes will cause inflammation of the respiratory 
tract and conjunctivae, and if the teeth are imperfect, 
may cause maxillary necrosis. 

Antagonists — Emollients. Synergists — Irritants. 

2. Internal Action. In the stomach in small doses it 
stimulates secretion and aids digestion. Large doses 
are violently irritant to the gastro-intestinal tract. 

Antagonists — Astringents. Synergists — Bitters, etc. 

3. Circulation. Small doses increase heart force. 
The facial capillaries are dilated, thus increasing the 
cutaneous circulation and causing diaphoresis. 

4. Nervous System. Being a normal constituent of 
nerve tissue, phosphorus is a tonic and food to the 
brain and nerves. Similarly it stimulates the growth 
of bone. 

5. Respiration. Is increased by the general nervous 
stimulation. Toxic doses depress the respiratory 
center. 

6. Metabolism. Nitrogenous waste and carbon diox- 
ide are diminished, and the glycogenic function of the 
liver is lessened. 



86 NOTES ON MATERIA MEDICA. 

7. Temperature. Is somewhat lowered by the in- 
creased radiation and evaporation. 

8. Absorption and Elimination. It is partly con- 
verted into phosphates in the stomach and so absorbed, 
partly dissolved by the fats and absorbed as elementary 
phosphorus. It is eliminated chiefly by the urine, in- 
creasing the phosphates, and partly by the liver. 

Untoward Action. Gastro-intestinal irritation, jaun- 
dice, retinal hemorrhage. 

Poisoning. — Acute. Symptoms. Taste of phos- 
phorus in the mouth, odor of phosphorus on the breath, 
thirst, fever, gastro-enteritis, sometimes constipation, 
enlarged liver, remission the third day, followed by 
renewed symptoms, coffee-ground vomiting ; absence 
of bile, jaundice, constipation, diminished urine with 
albumin or blood and bile coloring matter. Nervous 
symptoms. Twitching, headache, convulsions, death 
in a few days or several weeks. Later wholesale fatty 
degeneration. 

Treatment. Emetics, stomach pump, purgatives, 
copper sulphate, hydrogen peroxide, potassium per- 
manganate, old French oil of turpentine, magnesia, 
charcoal, stimulants. 

Poisoning. — Chronic. Symptoms. Maxillary necro- 
sis, etc. 

Administration. The drug is given usually three 
times daily after meals. It is commonly administered 
in pills. The elixir is a good preparation. Begin with 
small doses, and gradually increase. Calcium phos- 
phate, forming fifty per cent, of bone, increases the 
alkalinity of the blood, and diminishes the amount of 
urea. Sodium phosphate increases secretions gener- 
ally, especially that of bile. Hypophosphites are 
stimulating to the circulation and nervous system. 






ALTERATIVES. 87 

Therapeutics. Neurasthenia, paraplegia, locomotor 
ataxia, neuralgia of the fifth nerve, osteomalacia, rachi- 
tis, insomnia of cerebral anemia, functional impotence 

(4). 

OLEUM MORRHUAE. 

1. External Action. On the skin it is bland, but is 
readily absorbed when rubbed in on account of the bile 
salts, which render it more permeable to animal mem- 
branes. 

2. Internal Action. — Digestive Tract. In the 
stomach it may be nauseating, and is not absorbed. 
In the intestines it is emulsified, and is readily absorbed 
by the lacteals. It tends to produce laxativeness. As 
a fatty food it aids digestion. 

3. Blood. It is a valuable hematinic, increasing the 
number of red blood corpuscles. 

Antagonists — Mercury, etc. Synergists — Iron, arsenic, 
etc. 

4. Nervous System. It is a food and tonic to nervous 
tissues. 

Synergist — Glycerophosphates. 

5. Metabolism. The oil has alterative properties 
(iodine). It is a stimulant to protoplasm, increasing 
the output of waste material. Urea is increased. The 
drug is readily oxidized in the body, the patient gaining 
in weight. 

Untoward Action. Besides derangement of the 
digestive tract, the drug may cause an eczematous 
rash. 

Administration. The pure oil is usually best admin- 
istered, and should be given at first in small doses, 
which should be gradually increased as tolerance is 
established by the stomach. As the presence of the oil 
in the stomach may interfere with digestion, and as it 



88 NOTES ON MATERIA MEDICA. 

is not digested until it reaches the intestines, it 
should never be administered until gastric digestion 
is about completed, say in one-half to two hours after 
meals. Where the taste is repulsive, emulsions may be 
used or the oil may be given in capsules. 

Therapeutics. Certain skin diseases (i) ; marasmus, 
rachitis, wasting diseases, pertussis (i, 3, 5) ; tubercu- 
losis, scrofula, chronic bronchitis, anemia, abscess and 
exhausting conditions, certain nervous diseases, 
chronic nephritis, convalescence from acute diseases, 
catarrhal conditions (2, 3, 4, 5). 

Contra Indications. When it causes indigestion, 
fevers. 

GOLD AND SODIUM CHLORIDE. 

Its action is not definitely understood. It increases 
the fullness and frequency of the pulse, increasing 
arterial tension, and acting as an alterative and nerve 
tonic. If the dose is excessive or prolonged, gastro- 
intestinal inflammation or inflammation of other organs 
may be caused. 

Administration. It is given as pill, in solution or 
hypodermically. 

Therapeutics. As a nerve tonic in neurasthenia, hys- 
teria, neuralgia, alcohol habit, as an alterative in 
syphilis, scrofula, chronic rheumatism, chronic joint 
disease, degeneration of organs, spinal and cerebral 
scleroses. 



ANTIPERIODICS. 

CINCHONA. (Quinine.) 

Incompatibles — Tannic acid, ^alkalies, alkaline earths, 
iodine. Infusion and decoction with Fowler's solution. 
1. External Action. It is an antiseptic, and is irri- 
tant to broken skin and mucous membranes, but has 
no effect on the unbroken skin. 



ANTIPERIODICS. 89 

2. Internal Action. — Digestive Tract. Like the bit- 
ters, it is stimulant to gastro-intestinal glands, peris- 
talsis and local blood supply. Large doses may irritate 
the stomach. It is precipitated in the alkaline juices 
of the intestines. 

Antagonists — Belladonna, opium, etc. Synergists — Bit- 
ters, strychnine, etc. 

3. Circulation. At first small doses increase the 
force and frequency of the heart, and raise arterial 
tension. Large doses depress, toxic doses paralyze. 
In the blood it is kept in solution by the carbonic acid. 
Migratory movements of the white blood cells in the 
vessels are checked, but not outside. The red blood 
cells are increased in number, and their oxygen- 
carrying power is diminished. The plasmodium is de- 
stroyed. 

Antagonists — Cardiac stimulants. Synergists — Cardiac 
depressants. 

4. Nervous System. It is a cerebral stimulant in 
small doses, a cerebral congestant in large doses. Re- 
flexes are diminished by stimulation of the inhibitory 
center, later by direct depression of the spinal cord 
and nerves. "Nervousness" is sometimes produced by 
stimulation of the peripheral sensory nerve terminals. 

Antagonists — Nerve stimulants. Synergists — Nerve de- 
pressants. 

5. Respiration. Moderate doses have no effect, large 
doses depress. 

6. Temperature. No effect in the normal body. It 
lowers fevers from certain causes, e. g., malaria. It is 
not an universal antipyretic. 

7. Uterus. It increases the natural contractions of 
labor after they have begun. The drug probably does 
not produce abortion. 

Antagonists — Viburnum, opium, etc. Synergists — Ecbo- 
lics, 



90 NOTES ON MATERIA MEDICA. < 

8. Eye. The drug occasionally causes amblyopia, 
transitory blindness, color-blindness, dilated pupils. 

2. Absorption and Elimination. It is quickly ab- 
sorbed from the stomach. It is partly destroyed in the 
body, the rest is slowly eliminated by the kidneys 
chiefly. It lessens tissue waste, reducing the nitrogen- 
ous products in the urine. 

Untoward Action. Ringing in the ears, deafness, 
blindness, skin eruptions, irritable bladder, gastritis, 
middle ear hemorrhages. 

Poisoning. — Cinchonism. Symptoms. Similar to 
untoward action. If the dose be lethal, cardiac, and 
respiratory failure and collapse. 

Treatment. Potassium bromide, hydrobromic acid 
and cardiac and respiratory stimulants if needed. 

Administration. For administration to children it 
should be suspended in aromatic elixir of licorice. For 
adults it should be given in the dry powder or in cap- 
sules. The drug may be given as a suppository mixed 
with lard or by inunction. Quinine hydrobromate and 
the hydrochlorate are used hypodermically. Caution 
must be observed when thus used on account of cardiac 
depression. Aromatics and spices increase the effi- 
ciency of the drug. Quinine is best given on an empty 
stomach. 

Therapeutics. Alopecia, hay fever, whooping-cough, 
etc., gonorrhea, erysipelas, cystitis (i) ; malaria (3, 6) ; 
neuralgias, headache, asthma, jaundice, diarrhea, dys- 
entery, etc., of malarial origin, phthisis, fistulae, septi- 
cemia, pyemia, puerperal fever, first stage of endo- 
carditis, pneumonia, pleurisy (3) ; chorea, whooping- 
cough (4) ; labor, amenorrhea (7) ; atonic dyspepsia (2). 

Contra Indications. Acute inflammation of the gas- 
trointestinal and genito-urinary tract, inflammation* 
of the middle ear, meningitis, cerebritis, idiosyncrasy. 



ANTIPERIODICS. 



91 



METHYLENE BLUE. 

The drug is an efficient substitute for quinine in 
malaria where quinine has failed, or where idiosyn- 
crasy contraindicates. The drug is an antiseptic. 

Absorption and Elimination. It is quickly absorbed, 
and is eliminated by the bowels and kidneys, staining 
the excretions blue. It is thus an antiseptic of the 
urinary tract. 

Untoward Action. Nausea and vomiting, vertigo, 
stranguary. 

Administration. In capsules every four to six hours. 
A few drops of spirit of peppermint or other aromatic 
usually prevents untoward symptoms. 

Therapeutics. As a substitute for quinine in malaria 
affections, in gonorrhea, cystitis, etc. 



DRUGS HAVING LOCALIZED ACTION. 



BITTERS. 

SIMPLE BITTERS. 

Incompatibles — Salts of iron, lead and silver with gen- 
tian, calendula and aromatic bitters. 

Quassia, gentiana, calumbo (columba), calendula 
(marigold), chirata. 

External Action. None. 

Internal Action. — Digestive Tract. In the mouth 
they stimulate the afferent nerve terminals, and cause 
an increased secretion of saliva and gastric juice, by 
reflex action through the medulla and the vasomotor 
center and secretory nerves. In the stomach by local 
action secretion is further stimulated in a like manner. 
Through increased local blood supply absorption is 
increased. By reflex stimulation of Auerbach's plexus, 
peristalsis is increased. 

Antagonists — Opium, astringents, belladonna. Syner- 
gists — Strychnine, physostigma. 

AROMATIC BITTERS. 

Anthemis (chamomile), cascarilla, prunus Virginia 
(wild cherry), serpentaria (snake root). These, in 
addition to the action of simple bitters, are also anti- 
septic by reason of the volatile oil which they contain. 
In overdose or too long continued, aromatic bitters act 
as irritants, lessening the secretion of gastric juice, and 
increasing the secretion of mucus. [See "Volatile 
Oils," Class II.] 

Administration. They are best given in liquid form, 
though powders and solid extracts may be given. 



DIGESTANTS. 93 

They are best administered one-half to one hour before 
meals. 

Therapeutics. Atonic and fermentative dyspepsia, 
chronic gastric catarrh, anorexia, convalescence, de- 
lirium tremens. 

Quassia for seat worms. Wild cherry in bronchitis 
and phthisis. 

Contra Indications. Organic diseases of the stom- 
ach, during fevers, when appetite is good, alcoholic 
preparations in drunkard's catarrh, intestinal indiges- 
tion. 



DTGESTANTS. 

PEPSINUM. 

Incompatibles — Tannic and gallic acid, mineral salts, alco- 
hol, alkalies. 

Action. Its action, which is purely chemical, occurs 
in an acid medium of a strength not exceeding one-fifth 
of one per cent. It digests proteids, forming albu- 
moses, and then peptones. 

Administration. In powder, dissolved in glycerin 
or acidulated water, immediately after meals. If too 
long continued, it will impair the gastric function. 

Therapeutics. Atonic dyspepsia, cancer and ulcer 
of the stomach, peptonized food by rectum. 

PANCREATINUM. 

Incompatibles — Strong mineral acids. 

Action. Its action, which is chemical, occurs in an 
alkaline or very weak acid medium. It digests pro- 
teids, emulsifies fats and oils, resolving them into fatty 
acids and glycerin, converts starch into sugar, and 
curdles milk. 

Administration. In powders, capsules, or in solu- 



94 NOTES ON MATERIA MEDICA. 

tion with alkalies. It should be given two hours after 
meals or immediately after or with food. 
Therapeutics. As for pepsin. 

DIASTASE. 

Action. Its action is chemical. It converts starch 
into sugar until the acidity of the gastric juice reaches 
.1 of one per cent. 

Administration. Taka-diastase is the best prepara- 
tion, and may be given in tablets, capsules or solution. 

Therapeutics. "Amylaceous indigestion." 



EMETICS. 

Local. Alum, copper sulphate, zinc sulphate, yellow 
mercuric sulphate, sodium chloride, ammonium car- 
bonate, mustard. 

Systemic. Apomorphine hydrochlorate, antimony 
and potassium tartrate, ipecac, lobelia. 

ANTIMONY AND POTASSIUM TARTRATE. 

Incompatible* — Tannic and gallic acids, lead salts. 
i. External Action. Irritant to the skin, causing 
burning sensation, continued application causes inflam- 
mation, acne, vesicular and pustular eruptions like 
small-pox. 

Antagonists — Emollients. Synergists — Irritants. 

2. Internal Action. An irritant to mucous mem- 
branes. 

Digestive Tract. Small doses produce a sense of 
warmth, increasing salivary, gastric and intestinal 
secretions. In full doses the drug is an irritant, and by 
its local action is a slow, but powerful emetic, pro- 
ducing similar effects by stimulating the vomiting 



EMETICS. 



95 



center after absorption. It may cause purging and 
cramps. 

Antagonists — Bismuth, cerium oxalate, hydrocyanic acid. 
Synergists — Emetics. 

3. Nervous System. It paralyzes all of the spinal 
centers, sensory and motor, sensory peripheral nerve 
terminals, and motor nerves. Heat sensation is first 
lost. Convulsions may occur, due to cerebral anemia. 
The drug is a general muscle poison. 

Antagonists — Strychnine, caffeine, belladonna. Syner- 
gists — Chloral, physostigma, bromides, etc. 

4. Circulation. Pulse rate and pulse force lowered 
by the depression of heart muscle. Arterial tension is 
lowered by depression of the peripheral vasomotor 
terminals in the vessels, and possibly by depression of 
the vasomotor center; also by decrease in heart force: 

Antagonists — Digitalis, strychnine, belladonna, ergot. 
Synergists — Aconite, veratrum, etc. 

5. Respiration. Small doses stimulate bronchial 
secretions, but have little effect on the movements; 
large doses further stimulate bronchial secretions and 
by depression of the center render movements irregu- 
lar. Poisonous doses produce death in three ways, by 
depression of the respiratory center and the pneumo- 
gastric nerve, by pulmonary congestion due to cardiac 
failure, and by excessive bronchial secretions which 
cannot be expelled (drowning).' 

Antagonist — Belladonna. Synergists — Expectorants. 

6. Temperature. Unaffected by small doses, large 
doses cause a fall through the effect on the circulation. 

7. Absorption and Elimination. The drug is rapidly 
absorbed, and is eliminated by all avenues ; by bowels 
(purging), by skin (eruption like variola), by lungs 
(expectorant). 



96 NOTES ON MATERIA MEDICA. 

Untoward Action. Like poisoning. 

Poisoning. Symptoms. Like cholera, pulse slow 
and weak at first, skin moist, muscles relaxed, vomit- 
ing, gastric distress, purging with rice water stools, 
face wet and livid, pulse becomes rapid and shuttle- 
like, or absent at the wrist, arterial tension is nothing, 
respiration is faint and fleeting, cramps in the calves of 
the legs, temperature is lowered. 

Treatment. Tannic acid, stomach pump, prone posi- 
tion, external heat, alcohol, digitalis, opium (hypo- 
dermically) with strychnine if respiration is very 
feeble. 

Diagnosis from Cholera. By chemical examination 
and history. 

Administration. As an expectorant the wine is as 
good as any other preparation. Give every two to 
three hours. As an emetic give with ipecac in powder. 

Therapeutics. Acute inflammations, first stage of 
acute laryngitis, croup, bronchitis (4, 7) ; any condi- 
tions requiring an emetic (2). This drug is becoming 
less and less used. 

APOMORPHINE. 

1. External Action. None. 

2. Internal Action. No effect locally. Vomiting is 
produced by stimulation of the vomiting center; 
Emesis is usually repeated several times, nausea occa- 
sioned is slight, depression moderate. 

3. Circulation. Small doses have no effect. Full 
doses increase heart force and rate, and raise arterial 
tension (stimulation of the heart muscle, accelerator 
nerve, and vasomotor center). Large doses depress 
the heart muscle. 

4. Nervous System. Full doses stimulate the. brain 
(delirium), large doses cause convulsions, followed by 



EMETICS. - 97 

motor and sensory paralysis. Vomiting center stimu- 
lated. 

Antagonists — Bromides, chloral, etc. Synergists — Emet- 
ics. 

5. Respiration. Small doses increase secretions 
from the bronchial mucous membranes, full doses stim- 
ulate the respiratory movements, large doses depress. 

Antagonists— Belladonna, opium. Synergists — Expecto- 
rants. 

6. Absorption and Elimination. It is quickly ab- 
sorbed, and is eliminated by gastro-intestinal tract, the 
bronchial mucous membrane, the kidneys and the skin. 

Poisoning. Symptoms. Vomiting (very violent), 
delirium and convulsions, cardiac and respiratory de- 
pression. 

Treatment. Gastric sedatives, cardiac and respira- 
tory stimulants. 

Administration. For emesis give hypodermically. 
For expectorant effect give by the mouth. Always use 
freshly prepared solution. Children bear apomorphine 
badly. 

Therapeutics. Poisoning, as emetic in irritated con- 
dition of the stomach (2) ; acute and chronic bronchitis, 
etc. (5). 

Contra Indications. As for other emetics. 

IPECACUANHA. 

Incompatibles — -Tannic acid, metallic salts and caustic alkalies. 
i. External Action. It is irritant to the skin, pro- 
ducing, if long continued, vesication and pustulation. 
Antagonists — Emollients, astringents. Synergists — Irri- 
tants. 

2. Internal Action. It is irritant to mucous mem- 
branes, causing sneezing and asthma when inhaled. 
Digestive Tract. It is a local irritant in the mouth, 



9?> NOTES ON MATERIA MEDICA. 

causing salivation. In the stomach minute doses are 
stimulating, larger doses by local action cause vomiting 
without much nausea. This effect is further produced 
after absorption by action on the vomiting center in 
the medulla. In the intestines it acts as a purgative. 
In small doses it increases the flow of bile. 

Antagonists — Cocaine, cerium oxalate, bismuth, etc. Syn- 
ergists — Emetics, purgatives. 

3. Circulation. No direct effect from medicinal 
doses. 

4. Nervous System. Stimulation of the vomiting 
center is the only effect of medicinal doses. 

Antagonists — Bromides, chloral, etc. Synergists — Emet- 
ics. 

5. Respiration. No effect on the respiratory move- 
ments. It stimulates the bronchial mucous membrane 
increasing the secretions, which reflexly increases the 
cough. 

Antagonists — Belladonna, codeine, etc. Synergists — Ex- 
pectorants. 

6. Absorption and Elimination. The drug is rapidly 
absorbed, and is eliminated by the bowels, by the skin 
(stimulation of the sweat glands), by the kidneys, and 
by the lungs. 

7. Uterus. In small doses the drug is oxytocic. 
Untoward Action. Cutaneous irritation, conjuncti- 
val inflammation. 

Poisoning. Symptoms. Vomiting and purging with 
blood, pain, cardiac depression, muscular weakness, 
diminished reflexes, .cold sweat, lowered temperature. 

Treatment. Tannic acid, external heat, opium, bella- 
donna, cardiac stimulants. 

Administration. The powder is the best form in 
which to administer as an emetic or diaphoretic. The 



EMETICS. 



99 



syrup or the wine are better as expectorants. Admin- 
ister every three to four hours. Children bear ipecac 
well. 

Therapeutics. Croup, bronchitis, sick headache, 
vomiting, atonic dyspepsia, bilious dysentery, infantile 
diarrhea, hematomesis (2) ; rigid os uteri (7) ; hem- 
optysis, late stages of pneumonia, bronchitis, spas- 
modic asthma (6) ; remittent and intermittent fevers. 

Contra Indications. Aneurism, hernia, prolapses. 

LOBELIA. 

Incompatible s — Caustic alkalies. 

Internal Action. — Digestive Tract. It is an irritant 
emetic like ipecac, but it causes more nausea and pros- 
tration. 

Circulation. It depresses the heart muscles and 
the vasomotor center, lessening force and tension of 
the pulse. Poisonous doses paralyze. 

Nervous System. Full doses depress the motor 
nerve ganglia. Poisonous doses cause coma and con- 
vulsions. 

Respiration. It is slowed by small doses, is de- 
pressed or paralyzed by large doses. Bronchial mus- 
cular coats are relaxed. 

Absorption and Elimination. It is readily absorbed, 
and is eliminated by the kidneys and skin, acting as a 
diuretic and diaphoretic. 

Poisoning. Symptoms. Gastro-enteritis with col- 
lapse. 

Treatment. Cardiac and respiratory stimulants, 
external heat, etc. 

Administration. Any of the preparations may be. 
used, but the drug is not much employed. 

Therapeutics. Spasmodic asthma and bronchitis. 

L.cfC. 



IOO NOTES ON MATERIA MEDICA. •' 

COPPER SULPHATE AND ZINC SULPHATE. 

Incompatibles — Alkalies and their carbonates, sulphides, 
lime water, vegetable astringents. Copper further with 
iodides and mineral salts except sulphates. Zinc with sil- 
ver nitrate, lead acetate and milk. 

i. External Action. On the unbroken skin they have 
little effect On mucous membranes and on the broken 
skin they are powerfully astringent or mildly caustic, 
zinc being milder than copper. 

Antagonists — Emollients. Synergists — Caustics, etc. 

2. Internal Action. They are irritant to the mucous 
membrane of the stomach. By reflex action they pro- 
duce vomiting without much nausea. Unless promptly 
effective some other emetic should be used to empty 
the stomach and to prevent irritation. A second dose 
of zinc may be given, however. In the intestines in 
small doses they are astringent, but in large doses they 
are violently irritant. 

Antagonists — Bismuth, cerium oxalate, etc. Synergists— 
Emetics. 

3. Absorption and Elimination. When either drug 
is used as an emetic there is practically no absorption. 
With small doses absorption is slow, the drug tending 
to cumulate in the liver, zinc much less than copper. 
Both are sedative to the nervous system. If the dose 
is too large, cardiac depression may be induced. Cop- 
per is a tonic to the blood. They are eliminated by the 
liver, the kidneys, the intestinal tract, and copper by 
the salivary glands. 

Untoward Action. See "Poisoning." 

Poisoning. — Acute. Symptoms. Metallic taste, gas- 
tric pain, vomiting (colored green or blue from cop- 
per), purging, with mucus and blood, convulsions, 
salivation, headache, jaundice, defective coordination, 
coma. 






ANTI-EMETICS. 101 

Treatment. Potassium ferro-cyanide, albumin, oil, 
magnesium, opium, alkalies and their carbonates, stom- 
ach pump. 

Poisoning. — Chronic (rare). Symptoms. Bronchial 
and intestinal catarrh, colic and diarrhea, nausea, 
emaciation, anemia, paralysis, atrophy and fatty de- 
generation of the liver, green line on the gums from 
copper. 

Treatment. Hygiene, tonics, stimulants, potassium 
iodide. 

Administration. As an emetic, five to ten grains well 
diluted. As an internal astringent, one to two grains 
with opium. In the eye use a solution of five grains 
to one ounce. 

Therapeutics. — Copper Sulphate and Zinc Sulphate 
in ulcers, ring-worm, scabies, sore throat, conjunctivi- 
tis, stomatitis, gonorrhea, gleet (i), to produce erne- 
sis, croup, dysentery, diarrhea (2), chorea, hysteria, 
epilepsy, anemia (3). Zinc Acetate in conjunctivitis, 
gonorrhea (1). Zinc Carbonate in moist skin diseases 
(1). Zinc Chloride in certain eye diseases and gonor- 
rhea. Zinc Oxide in eczema, burns, fissured nipples, 
anal fissure, ulcers, erysipelas, leucorrhea (1), diarrhea, 
dysentery (2), hysteria, spasmodic asthma, chorea, epi- 
lepsy, whooping-cough, delirium tremens (3). 



ANTI-EMETICS. 

Local. Alcohol, arsenic (small doses), belladonna, 
bismuth subnitrate and subcarbonate, cerium oxalate, 
carbolic acid, chloroform, cocaine, creosote, calomel, 
ether, ipecac (small doses), ice, opium, hydrocyanic 
acid, menthol, potassium nitrate, silver nitrate, sulpho- 
carbolates, tincture of iodine (small doses). 

Systemic. Alcohol, ammonia, amyl nitrite, bromides, 
chloral, hydrocyanic acid, nitroglycerin, opium. 



102 NOTES ON MATERIA MEDICA. 

CATHARTICS. 

General Manner of Action. Saline cathartics, if 
stronger than the normal saline solution, abstract 
water from the blood vessels in the intestinal canal. 
Other cathartics act by stimulating peristalsis, pro- 
ducing intestinal hyperemia, and increasing glandular 
activity. Cathartics are classified, according to the 
degree of their action, under the usual dosage as : laxa- 
tives, simple purgatives, hydragogue purgatives and 
drastic purgatives, but it must be remembered that this 
classification is based on their degree of activity, and 
that large doses of simple purgatives, for instance, may 
be hydragogue, aud that small doses of hydragogues 
may act as laxatives only. Most cathartics act by 
immediate contact with the intestinal mucous mem- 
brane, some, noted below, in the course of excretion. 

Antagonists — Opium, belladonna, astringents. Syner- 
gists — Strychnine, volatile oils, etc. 



LAXATIVES. 

OLEUM RICINI. 

It is mildly irritant to the intestinal mucous mem- 
brane, and acts in from four to six hours, usually with- 
out much pain. It acts on the small intestine directly 
and in elimination. Habitual use causes constipation. 

Administration. To disguise the taste mix with 
equal parts of glycerin or aromatic elixir, with a few 
drops of oil of cinnamon added or oil of peppermint. 
It may be given in whiskey, beer, or coffee, or in cap- 
sules, but these are bulky. 

RHAMMUS PURSHIANA. (Cascara Sagrada.) 
Owing to the bitter principles which this drug con- 
tains it is a stomachic stimulant, and is mildly irritant 
to the small intestine. It acts in from six to ten hours, 



SIMPLE PURGATIVES. 103 

usually without pain, and does not increase constipa- 
tion after purgative action. The solid or the fluid 
extract are the best preparations, and their activity 
may be increased by mixing with equal parts of glyce- 
rin, and by the addition of a few drops of spirit of 
peppermint. The cordials are not so efficient as the 
plain fluid extract. The drug may be given in capsules. 
For constipation, after a few days' use in regular dose, 
the amount should be gradually decreased. 

MANNA. 

Mildly irritating to the intestines. It is slow in its 
action, and tends to produce constipation after its laxa- 
tive effect. 

SULPHUR. 

Parasiticide, antiseptic, and slightly irritant to the 
skin by the formation of hydrogen sulphide. In the 
intestines it is partially converted into sulphides, which 
stimulate secretion and peristalsis. It is very slow in 
its action, and may cause flatulence. It is eliminated 
chiefly by the intestines, but partially by the kidneys, 
lungs, skin and lacteal glands. May cause rash, and, 
if long continued, impairs the quality of the blood, and 
may cause muscular weakness. It may be adminis- 
tered as lozenges, in capsules, in milk or other vehicle, 
or in the form of baths. 



SIMPLE PURGATIVES. 

ALOES. 

This drug is readily absorbed from the abraded skin. 
It stimulates gastric secretions somewhat. It stimu- 
lates the flow of bile, and exerts its principal action on 
the lower part of the large intestine in elimination. It 
stimulates peristalsis more than secretion. The drug 
acts slowly in from ten to fifteen hours, causing soft, 



104 NOTES ON MATERIA MEDICA. 

dark stools, with more or less griping. It is readily 
absorbed. Pelvic circulation is increased (hemorrhoids 
and abortion). Elimination chiefly by the bowels, and 
partially by the kidneys and milk. It is best adminis- 
tered in pill form. 

FEL BOVIS. 
Augments duodenal secretions,, emulsifies fats, and 
increases peristalsis, and is an intestinal antiseptic. It 
is best given in pill form. 

RHEUM. 

In moderate doses it is a stomachic stimulant and 
bitter astringent. Its action on the small intestine is 
stimulation of the circulation of the glandular append- 
ages and stimulation to the liver. It produces soft, 
yellow stools in from four to eight hours, with griping. 
By its astringent properties it increases constipation 
after purgative effect. It is excreted by the intestines, 
by the kidneys, skin and lacteal glands, all secretions 
being tinged yellow. It is best administered to chil- 
dren as syrup, to adults in pill form. 

SENNA. 

It stimulates the intestinal circulation, the intestinal 
secretion, and peristalsis throughout the small intes- 
tines, producing copious, liquid, yellow stools in six to 
eight hours, with griping and flatulence. It does not 
tend to constipation. The drug is eliminated by the 
intestines, by the kidneys, and by the lacteal glands. It 
colors the urine red. All preparations are used. 



HYDRAGOGUE PURGATIVES. 

OLEUM TIGLII. 

Externally it is a powerful irritant to the skin, pro- 
ducing inflammation, with vesication and pustulation. 
Internally it produces a sensation of warmth in the 



SALINES. I05 

stomach. It causes congestion and hyperemia of the 
intestines, increasing the glandular activity and peris- 
talsis. It produces profuse watery stools in from one- 
half to two hours. Large doses cause violent gastro- 
enteritis, with collapse and the usual symptoms of 
irritant poisoning. Treat like other irritant poisons. 
It may be administered in emulsion or on sugar, but is 
best administered in pills made with bread crumbs. 
Purgative effects may be produced by external applica- 
tion. 

ELATERIUM. (Elaterin.) 

This is the most powerful of all of the hydragogue 
purgatives. It stimulates the salivary, gastric and in- 
testinal secretions, and those from the liver and the 
pancreas. It is a violent purgative, and acts on the 
large intestine, producing prompt free watery stools, 
with much griping and prostration. It may be given 
in pill, in alcoholic solution or triturated, and must be 
used cautiously. 

CAMBOGIA. 

It is a violent hydragogue purgative, and stimulates 
peristalsis greatly, causing great increase in intestinal 
secretions. In small doses and repeated doses it is 
slightly diuretic, coloring the urine yellow. It may 
cause griping, and has anthelmintic properties. 



SALINES. 



Magnesia, magnesium carbonate, magnesium citrate, 
solution of effervescent magnesium citrate, magnesium 
sulphate (Epsom salts), potassium tartrate, potassium 
and sodium tartrate (Rochelle salts), sodium phos- 
phate, sodium sulphate (Glauber's salts). 

Magnesia and magnesium carbonate are antacids, 
becoming mildly laxative after being acted upon by the 



106 NOTES ON MATERIA MEDICA. 

gastric juice. Their action is increased when they are 
administered with lemon juice. They are absorbed 
into the blood with difficulty, but when absorbed, they 
act as do the other alkalies. 

The salines cause purgation by preventing absorp- 
tion from the intestines when in weak solution, and by 
abstracting the water from the blood vessels into the 
intestines if in solution stronger than 7 to 1,000. Peris- 
talsis is stimulated by the greater bulk in the intestines. 
Sodium sulphate and sodium phosphate are mild 
hepatic stimulants. Sodium salts are more active 
purgatives than potassium salts, producing watery 
stools in from one to three hours. The salines should 
be administered quite concentrated on an empty 
stomach. 



DRASTIC PURGATIVES. 

COLOCYNTHIS. 

This drug is a harsh and powerful purgative. It 
stimulates secretions throughout the whole gastro- 
intestinal tract, and causes violent peristalsis. It is a 
hepatic stimulant and cholagogue. It is eliminated by 
the liver and the intestines, and promptly produces 
watery stools. In large dose it will cause violent 
gastro-enteritis. 

JALAPA. 

It is active in the small intestines. The drug stimu- 
lates intestinal secretions and circulation, and also 
peristalsis, producing profuse watery stools, with much 
griping, in. from three to four hours. 

Compound Jalap Powder is usually preferred to the 
other preparations of jalap. It has some anthelmintic 
properties. 



CATHARTICS IN GENERAL. 107 

SCAMMONIUM. 

Identical in its action with jalap, except that its 
effects on the muscular coat of the intestines is greater, 
thus causing more griping. It stimulates secretions. 
The drug is inactive in pill form, and should be given 
in powder or emulsion. 

PODOPHYLLUM. 

This drug is irritant to the skin, and to mucous 
membranes when inhaled. It may be absorbed from 
raw surfaces, and produce purgative effect. When 
swallowed, it is apt to cause nausea. It exerts its effect 
in the small intestine, rendering peristalsis very rapid, 
and greatly increasing the secretions, especially the 
bile. It produces liquid, bile-stained stools in from 
ten to twelve hours, with much griping. It should be 
combined only with other slow acting drugs. 



ADMINISTRATION OF CATHARTICS IN GEN- 
ERAL. 

These drugs should be so combined as to affect the 
entire intestinal tract. Hyoscyamus or belladonna 
should be given with those which cause griping. Their 
action is more prompt if they are administered upon 
an empty stomach, the salines by preference before 
breakfast, the slow T -acting purgatives at bed-time. 

Therapeutics. Simply to remove feces (laxatives) ; 
to relieve chronic constipation (aloes, cascara, mag- 
nesia, sodium phosphate, podophyllum) ; to remove 
pathogenic matter from the bowels (mercurial prepara- 
tions) ; to stimulate the liver (aloes, podophyllum, 
sodium phosphate, colocynth) ; to deplete the gastro- 
duodenal membrane (sodium salts and other salines) ; 
to remove dropsical effusions (hydrogogue purga- 



108 NOTES ON MATERIA MEDICA. 

tives) ; to supplement inefficient elimination of urea, 
etc. (drastic purgatives) ; to increase menstrual flow 
(aloes). 

Contra Indications. Inflammation of the mucous 
membrane of the gastro-intestinal tract. Hydragogue 
or drastic purgatives in appendicitis, peritonitis, preg- 
nancy, intussusception, etc. 

Therapeutics other than cathartic: 

Castor Oil. Protective dressing in superficial ulcera- 
tion. 

Sulphur. Locally, certain diseases of the skin, nose 
and throat. Internally, in bronchitis, chronic rheu- 
matism, eczema. 

Croton Oil. Locally in intercostal neuralgia, chronic 
bronchitis, congestive dysmenorrhea, congestion of the 
uterus. 



ANTHELMINTICS. 

These drugs are used to expel or kill the intestinal 
worms. 

CHENOPODIUM. 

This drug expels round worms, and should be fol- 
lowed in its administration by a cathartic. 

SANTONICA. 

Is used to expel round worms. The drug is irritant, 
and may, if given in large doses, cause nausea and 
vomiting, with pain, diarrhea, etc. Large doses may 
cause giddiness, headache, hallucinations of smell and 
taste, yellow vision or perception of other colors may 
be induced. Sometimes urticaria. It is eliminated by 
the kidneys, coloring the urine yellow if acid, red if 
alkaline. 

It should be given on an empty stomach, and is 



ANTHELMINTICS. 109 

usually accompanied by calomel, and followed in a 
few hours by some other brisk cathartic. 

Poisoning. Symptoms. Unconsciousness, twitching 
of the eye-balls, dilated pupils, cold sweat, weak pulse, 
feeble respiration and sudden death. 

SPIGELIA. 

It causes the expulsion of the round worm. It 
should be combined with cathartics and aromatics to 
prevent absorption, which may induce the symptoms 
of narcotic poisoning. 

ASPIDIUM. 

This drug causes the expulsion of the tape worm, 
and may be administered in emulsion or in capsules. 
In large doses it is irritant to the gastro-intestinal 
tract. For efficiency the drug should be given after 
at least tw r enty-four hours of practical fasting, by 
preference in the morning, and preceded the night 
before by a brisk purge. A few hours after its admin- 
istration another brisk purge should be given to aid 
in. the expulsion of the worm. If the head does not 
come away, the treatment must be shortly repeated. 

cusso. 

Similar in its effects and administration to aspidium. 

GRANATUM. 

This is an efficient anthelmintic against the tape- 
worm. A decoction of the bark is the usual form of 
administration, but it is efficient only when the drug is 
fresh. Otherwise it is like aspidium. Tannate of pelle- 
tierine is more reliable. 

KAMALA. 
This drug is effective against all kinds of worms, and 
in its administration resembles aspidium. 



1 10 NOTES ON MATERIA. MEDICA. 

PEPO. 

Causes destruction and expulsion of tape-worms. 
An infusion of the crushed seed is used, about a pint 
being administered in from three to four doses at inter- 
vals of from one to two hours. In its administration it 
resembles aspidium. 



HEMATICS. 

Iron, manganese, phosphorus, cinchona, arsenic, 
cod liver oil. 

FERRUM. 

Incompatible* — Ferric salts with tannic and gallic acids 
and acacia. Carbonates with acids and acidulous salts. 
Iodides and salts of vegetable acids with tannic and min- 
eral acids, alkalies and their carbonates. Tincture of the 
chloride with tannic acid, alkalies and their carbonates, 
lime water. 

In general its action is chiefly that of a local astrin- 
gent, to increase the oxygen-carrying power of the 
red blood corpuscles, and to convert the oxygen in the 
tissues into ozone. 

i. External Action. No action on the unbroken skin. 
Ferric and ferrous preparations are astringent to 
broken skin and to mucous membranes, coagulating 
the albumin, and by this property acting as hemo- 
statics. 

Antagonists — Irritants. Synergists — Astringents. 

2. Internal Action. — Digestive Tract. In the mouth 
they produce a styptic taste. Astringent preparations 
pucker the mouth. The tongue and teeth are blackened 
(formation of ferrous sulphide). In the stomach all 
iron preparations are converted into ferric chloride. 
Strongly acid salts may irritate the stomach (liberation 
of free acid and formation of ferric chloride). Small 



HEMATICS. Ill 

doses by stimulation and astringent properties act as 
stomachic tonics. In the intestines iron is converted 
into alkaline albuminate and other soluble salts, and 
into insoluble sulphide and tannate, in which forms 
they are excreted, blackening - the feces. Astringent 
preparations constipate. 

Antagonists — Laxatives. Synergists — Astringents. 

3. Circulation. On entering the blood, the iron com- 
bines with the red blood cells, increasing their oxygen- 
carrying power. The hemoglobin is increased, and 
probably the number of red blood cells also. In the 
tissues iron converts oxygen into ozone. It slightly 
stimulates the cardiac force, and raises arterial tension. 

4. Nervous System. Is improved by the better con- 
dition of the blood. 

5. Respiration. Is improved by the better condition 
of the blood. 

6. Temperature. Is somewhat raised by the better 
oxidation caused in the body. 

7. Absorption and Elimination. The chloride in the 
stomach and the albuminate in the intestines are ab- 
sorbed in small amounts. Organic preparations are 
absorbed. Some claim that no inorganic preparations 
are absorbed, and explain the benefits, clinically de- 
monstrable, by the supposition that their presence pre- 
vents decomposition in the intestines of the organic 
iron of the food, which is then entirely absorbed. 
Elimination is chiefly by the intestines. A very small 
amount is -eliminated by the kidneys, slightly stimu- 
lating their function. 

Untoward Symptoms. Headache, impaired diges- 
tion, nausea, constipation, acne, hemorrhage, plethora. 

Poisoning. Symptoms. Like those of other irritant 
poisons. 



1 12 NOTES ON MATERIA MEDICA. 

Treatment. Emetics, tannic acid, alkaline solutions, 
demulcent drinks, etc. 

Administration. Always give after meals unless 
local effects on the stomach are desired. Give acid 
preparations through a tube to protect the teeth. 
Strong preparations should be well diluted. Adminis- 
ter three times daily in small doses. The drug is not 
to be used in plethoric individuals. 

Therapeutics. Relaxed condition of the pharynx and 
larynx, diphtheria, chronic ulcers, epistaxis (i) ; ane- 
mia, chlorosis, scrofula, syphilis, nephritis, jaundice, 
chorea, neuralgias, certain chronic nervous diseases, 
incontinence of the urine, seminal emissions, erysipe- 
las, septicemia, diphtheria, amenorrhea, menorrhagia 
(3) ; chronic diarrhea, chronic dysentery, intestinal 
hemorrhage (2) ; hemorrhage of the kidneys, bladder, 
etc. (7). 

Contra Indications. Acute inflammatory conditions 
and fevers, anemia due to malignant disease, hemor- 
rhagic diathesis. 

MANGANESE. 
Incompatibles — Salts of lead, silver and mercury. 

External Action. Potassium permanganate when 
moist gives up oxygen in the presence of organic sub- 
stances. It is therefore an antiseptic and disinfectant. 

Internal Action. Manganese salts are gastro- 
intestinal irritants in large doses. In small doses they 
promote digestion. Large or long continued doses 
cause muscular and cardiac weakness and fatty degene- 
ration. The drug is very slightly absorbed into the 
blood, and does not replace iron in therapeutics, as the 
red blood corpuscles do not incorporate it. The dioxide 
given in large doses is an efficient emmenagogue. The 
sulphate is a cholagogue purgative, but is unsafe. 



EXPECTORANTS. 1 13 

Therapeutics. The dioxide in amenorrhea and dys- 
menorrhea, gastralgia, ulcer of the stomach, associated 
with iron in chlorosis and anemia. 



EXPECTORANTS. 

Depressant. Alkalies, antimony and potassium tar- 
trate, apomorphine, ipecac, lobelia, pilocarpus, potas- 
sium iodide. 

Stimulant. Acids, ammonium carbonate and chlo- 
ride, balsams of pern and tolu, benzoin and benzoic 
acid, copaiba, cubeba, glycyrrhiza, senega, squill, tar, 
terebene, turpin hydrate, turpentine. 

TEREBINTHINA. 

Incompatible s — Bromine, iodine, nitric and sulphuric acids. 

1. External Action. Antiseptic. On skin it pro- 
duces reddening, tingling, blistering, and may be ab- 
sorbed from the broken skin and produce systemic 
effects. May cause erythematous rash and desquama- 
tion. The fumes inhaled will produce irritation of the 
air passages. 

Antagonists — Emollients. Synergists — Irritants. 

2. Internal Action. — Digestive Tract. In the mouth 
the drug produces a sensation of warmth with reflex 
salivation. In the stomach the drug stimulates the 
gastric mucous membrane and the local circulation, 
thus increasing absorption. Large doses cause vomit- 
ing, purging and tenesmus. 

Antagonists — Bismuth, astringents, etc. Synergists — Vol- 
atile oils, etc. 

3. Circulation. The heart and vasomotor center are 
first stimulated, force and tension being increased. 
Large doses depress by local action on the blood ves- 



114 NOTES ON MATERIA MEDICA. 

sels. The drug acts as a hemostatic, causing contrac- 
tion. 

Antagonists — Aconite, etc. Synergists — Volatile oils, al- 
cohol, etc. 

4. Nervous System. The drug is a stimulant to the 
brain and spinal cord. Large doses depress, causing 
delirium or stupor, impaired coordination, lessened 
muscular power, dilated pupils. Death by paralysis of 
respiration. 

Antagonists — 'Bromides, chloral, etc. Synergists — Caf- 
feine, coca, strychnine, etc. 

5. Respiration. Stimulated by small dose ; depressed 
by large. 

6. Temperature. The drug is mildly antipyretic. 

7. Absorption and Elimination. The drug is rapidly 
diffused and is rapidly eliminated by the kidneys, lungs, 
bowels and skin. It stimulates the organs of elimina- 
tion, imparting its odor to the breath and a violent odor 
to the urine. 

Untoward Action. Skin eruptions, strangury, dizzi- 
ness, drowsiness, irritation of the mouth and stomach. 

Poisoning. Symptoms. Great muscular weakness, 
abolished reflexes, violent vomiting and purging, with 
blood, irritation of the genito-urinary tract, bloody 
urine or suppression, skin moist, face flushed, slow, 
labored breathing, dilated pupils, depressed circulation, 
mental excitement or insensibility. Death due to car- 
diac failure. 

Treatment. Empty the stomach, demulcent drinks, 
opium for pain, cardiac and respiratory stimulants. 

Administration. Give on sugar or in capsules or 
milk. Watch for effect on the kidneys, shown first by 
"smoky urine." As an enema, use with some demul- 
cent, and give every six hours or oftener. Stupes. 

Therapeutics. Lumbago, neuralgia, myalgia, rheu- 



EXPECTORANTS. 1 15 

matism, bronchitis, pleurisy, chronic inflammations, 
tympanitis, peritonitis, lacerated wounds, certain skin 
diseases (1) ; excessive bronchial secretion, capillary 
oozing, diphtheria (1, 3) ; flatulence, typhoid fever, tym- 
panitis, chronic intestinal catarrh {2) ; intestinal hem- 
orrhage, hemoptysis, hematemesis, menorrhagia, 
typhoid, pneumonia and other fevers (3) ; bronchor- 
rhea, chronic bronchitis, gleet, sub-acute gonorrhea, 
etc. (/) ; tape-worm and phosphorus poisoning. 

Contra Indications. Acute inflammation of the gas- 
trointestinal and genito-urinary tracts. 

TEREBENE. 
i. External Action. It is antiseptic, stimulant and 
astringent to the skin. 

2. Internal Action. — Digestive Tract. Small doses 
stimulate the secretions of the stomach and intestines, 
large doses irritate. 

3. Elimination. By the bronchial mucous mem- 
brane, kidneys and skin, exerting its astringent and 
antiseptic action. 

Therapeutics. As an antiseptic to wounds, ulcers, 
etc. (1) ; chronic bronchitis, bronchorrhea, emphy- 
sema, genito-urinary diseases (3) ; flatulent dyspepsia 

(2). 

Administration. Give in emulsion, capsules or on 
sugar. 

TURPIN HYDRATE. 

Like turpentine, it is stimulant and antiseptic to 
bronchial mucous membrane in excretion. 

BALSAM PERU AND BALSAM TOLU. 
Incompatibles — Aqueous preparations. 
They are antiseptic and stimulating -to raw surfaces, 
and to the skin. Elimination is by all avenues, exert- 
ing its action in the course of excretion. 



Ii6 ^OTES ON MATERIA MEDICA. 

BENZOIN AND BENZOIC ACID. 

Incompatibles — Benzoic acid with alkaline salts, am- 
monium benzoate with ferric salts. 

1. External Action. If concentrated, it is irritant to 
the skin, and to mucous membranes. It is a powerful 
antiseptic. 

2. Internal Action. — Digestive Tract. It is stimu- 
lant in small doses, and irritant in large. The liver is 
stimulated by sodium benzoate. 

3. Circulation. It is stimulant in large dose. 

4. Respiration. Powerful stimulant in moderate 
doses. 

5. Temperature. The drug is mildly antipyretic. 

6. Elimination. By the kidneys, skin, salivary glands 
and bronchial mucous membrane, stimulating their 
function. It renders the urine acid. 

Untoward Action. Besides irritation of mucous 
membranes, under large doses the drug sometimes 
causes urticaria. 

Therapeutics. CutaneQus wounds, chapped hands, 
frost bite, cracked nipples, catarrhal affections of the 
larynx and pharynx. By inhalation for hoarseness, 
chronic bronchitis. Locally on ulcers, specific sores, 
chancroids, chancres (1) ; cystitis, pyelitis, inconti- 
nence due to alkalinity (6). 

Administration. Benzoic acid in pills or in capsules. 
Benzoates in aromatic waters or pills. Benzoin by 
inhalation with steam. 

PIX LIQUIDA. 

1. External Action. Stimulant, antiseptic, astrin- 
gent ; prolonged use may cause papular eruption. 

2. Internal Action. — Digestive Tract. The drug 
stimulates mucous membranes generally, and if long 
continued will impair digestion. 



EXPECTORANTS. 117 

3. Circulation. Is mildly stimulated at first, con- 
tinued use will cause depression. 

4. Elimination. It is eliminated chiefly by the lungs, 
stimulating the mucous membrane, in part by the 
kidneys. 

Untoward Action. Excessive doses may cause head- 
ache, gastric pain, nausea and vomiting, also smoky 
urine. 

Therapeutics. Diseases of the skin, ulcers, cracked 
nipples, pruritus, diseases of the nose and throat (1) ; 
chronic bronchitis, advanced acute bronchitis, gleet, 
vesical catarrh, leucorrhea (4). 

Administration. It is given in milk, beer, or in pill 
form. Syrup, wine and tar water are the most palat- 
able. 

SENEGA. 

1. External Action. It is irritant to the skin, and to 
mucous membranes. Inhalation of the dry powder will 
cause sneezing, cough and increased bronchial and 
nasal flow. 

Antagonists — Emollients. Synergists — Irritants. 

2. Internal Action. — Digestive Tract. Small doses 
stimulate, large doses irritate. 

Antagonists — Bismuth, etc. Synergists — Irritants. 

3. Circulation. It is stimulated, the drug acting 
somewhat like digitalis, but much less powerfully. 

4. Respiration. Is affected only in elimination. 

5. Elimination. By the bronchial mucous mem- 
brane, increasing secretions and reflexly the cough, and 
by the kidneys and the skin, being diuretic and diapho- 
retic. 

Antagonists — Belladonna, opium. 

Untoward Action. Irritation of the alimentary tract. 
Therapeutics. Sub-acute bronchitis, bronchorrhea, 



Il8 NOTES ON MATERIA MEDICA. 

chronic bronchitis, with profuse expectoration, catarrh, 
laryngitis (5); amenorrhea (3). 

Contra Indications. Acute bronchitis, irritation of 
the gastro-intestinal tract. 

Administration. Any of the preparations, 

EUCALYPTUS. 

Incompatibles — Mineral acids and salts, alkalies. 

1. External Action. It is antiseptic and irritant, and 
is rubifacient, vesicant and pustulant if confined. 

Antagonists — Emollients. Synergists — Irritants. 

2. Internal Action. Mild doses stimulate glands and 
peristalsis, large doses may cause vomiting and purg- 
ing. 

Antagonists — Belladonna, opium, bismuth. Synergists — 
Strychnine, physostigma, bitters. 

3. Circulation. Force and frequency of the heart's 
action is increased by moderate doses. 

4. Nervous System. Small doses stimulate the cere- 
brum. Large doses may cause somnolence or insom- 
nia. Larger doses depress the brain, cord and medulla, 
abolishing reflexes, and causing loss of sensation in the 
lower limbs. 

5. Respiration. Small doses stimulate, large doses 
depress and paralyze. 

6. Special Action. Antimalarial. 

7. Absorption and Elimination. The drug is rapidly 
absorbed, and is eliminated by the kidneys, lungs, skin 
and bowels, stimulating their function, and exerting 
its antiseptic influence. 

Antagonists — Belladonna, opium, etc. 
Therapeutics. Chronic inflammation of mucous 
membranes (2, 7) ; certain skin diseases, sluggish 
wounds and ulcers (1) ; fermentative diarrhea, typhoid 



DIURETICS. 119 

fever (2) ; chronic malaria (6) ; genito-urinary anti- 
septic (7) ; bronchorrhea, pulmonary gangrene, fetid 
bronchitis (7). 

GLYCYRRHIZA. 
The drug is demulcent, stimulates salivary flow, and 
acts as a laxative. Elimination is by the bronchial 
mucous membrane, increasing its secretions. 



DIURETICS. 

By affecting arterial tension, cardiac stimulants, 
nitrites. 

Acting locally on the kidneys, scoparius, buchu, juni- 
per, turpentine, copaiba, cantharides, caffeine, diuretin, 
calomel, potassium acetate, citrate and nitrate, sodium 
citrate. 

Copaiba, cubeba, oleum santali, buchu, juniper. 
These drugs have in general the action of the volatile 
oils, their effects being pronounced stimulation and 
disinfection of the urinary tract. Copaiba has a nause- 
ous, bitter taste, and produces eruptions and anorexia. 
The urine will give the reaction of albumin with nitric 
acid, but the cloud disappears under heat or alcohol. 

Untoward Action. This class of drugs may produce 
skin eruptions and gastro-intestinal irritation. Too 
long continued, or in too great quantity, they may 
cause severe renal irritation, producing scanty albu- 
minous urine, casts desquamative nephritis. Juniper 
is not diuretic in health. 

Poisoning. Symptoms and treatment like turpen- 
tine. ["Volatile" Oils," Class IV.] 

DIURETIN. 

Incompatibles — Acids. 
Internal Action.— Digestive Tract. It sometimes 
causes nausea and vomiting. 



120 NOTES ON MATERIA MEDICA. 

Circulation. Arterial tension is raised by stimula- 
tion of the vasomotor center. 

Antagonists — Cardiac and vasomotor depressants. 

Nervous System. Large doses may cause headache, 
insomnia, etc. 

Absorption and Elimination. It is quite rapidly ab- 
sorbed, and is eliminated by the kidneys, stimulating 
the renal epithelium. The drug seems to have no effect 
in health on the urine. 

Synergists — Diuretics. 

Untoward Action. Irritation of the gastro-intestinal 
tract, somnolence, headache, ringing in the ears, erup- 
tions^ 

Administration. It should be given in capsules or in 
solution, but never in powders. It is best to begin with 
moderate dose, and then increase. Give between meals 
to avoid the action of the gastric juice. As much as 
ioo to 150 grains may be given in twenty-four hours. 

Therapeutics. To remove accumulation of fluid in 
the tissues or cavities (digitalis, squill, scoparius, diure- 
tin, copaiba) ; to remove waste products from the 
blood (alkaline diuretics, turpentine, juniper, etc.) ; to 
prevent or dissolve urinary concretions (lithium salts, 
piperazine). The volatile oil series of this class of 
drugs are used in chronic bronchitis. 

Contra Indications. Acute inflammation of the gas- 
tro-intestinal or genito-urinary tracts. 

PIPERAZIN. 

Incompatibles — Alkaloids, tannic acid, cinchona, iron, 
alum, Donovan's solution, acetanilid, phanacetin, sodium 
salicylate. 

Its only action is to dissolve uric acid, forming with 
it a very soluble salt. It does not increase the quantity 



DIAPHORETICS. 121 

of urine, but increases urea, and decreases uric acid. 
Large doses may cause nervousness, hallucinations and 
spasms. It is not irritant to mucous membranes. 
Synergist — Lithium. 

Administration. In solution in water or in aerated 
water. 

Therapeutics. Locally to gouty joints, vesical ca- 
tarrh. Internally in gout, uric acid calculi, chronic 
cystitis, renal colic. 



DIAPHORETICS. 

Pilocarpus, solution of ammonium acetate, sweet 
spirits of nitre, Dover's powder. 

PILOCARPUS. 
Incompatibles — Tannic acid, caustic alkalies, metallic salts. 

1. Internal Action. It stimulates the flow of salivary 
and gastric glands, and increases peristalsis. Large 
doses will cause nausea and vomiting. 

Antagonists — Belladonna, opium. Synergists — Bitters, 
strychnine, etc. 

2. Nervous System. No effect by medicinal doses 
other than stimulating the nerve terminals of the in- 
voluntary muscles. 

Antagonist — Belladonna. Synergist — Ergot. 

3. Circulation. Cutaneous vessels are dilated. 
Action is at first stimulated, and then depressed. 

Antagonist — Belladonna. Synergist — Opium. 

4. Temperature is considerably lowered. 

5. Eye. Pupils are contracted by stimulation of the 
oculo-motor nerve, and intra-ocular tension is in- 
creased. 

Antagonist — Belladonna. 



122 NOTES ON MATERIA MEDICA. 

6. Absorption and Elimination. Both rapid. It is 
eliminated by the kidneys, increasing the urine if the 
dose is small. The elimination of urea is largely in- 
creased. Also by the skin, stimulating the sweat 
glands and their nerves. Later it causes vasomotor 
palsy, sweat is tremendously stimulated, being at first 
acid, then neutral and then alkaline. Lachrymal and 
mammary secretions are also stimulated. 

Antagonists — Belladonna, opium. Synergists — Diapho- 
retics, diuretics. 

Untoward Action. Pain, nausea, vomiting, head- 
ache, pain in the urethra and in the lumbar region, 
vertigo, dim vision and stupor. 

Poisoning. Symptoms. Like untoward action with 
diarrhea, profuse depressing sweat, collapse. 

Treatment. Tannic acid, stomach pump, atropine, 
morphine, cardiac stimulants. 

Administration. It is best given hypodermically, but 
may be given in elixir, or preparations of jaborandi by 
the rectum. 

Therapeutics. Dryness of the throat (i) ; certain 
diseases of the eye (5) ; nephritis, renal dropsy, pleu- 
ritic effusion, uremic poisoning, erysipelas, malarial 
paroxysms (2) ; humid asthma, bronchorrhea, sweat- 
ing of phthisis, ptyalism, mumps, adenitis, diabetes 
insipidus, chronic diseases of the skin, colds, catarrhal 
jaundice, belladonna poisoning (6) ; as a galactagoguc, 
alopecia. 

Contra Indications. Weak heart, atrophy and fatty 
degeneration of the heart and blood vessels, tendency 
to pulmonary congestion and edema, asthenic fevers. 



EMMENAGOGUES AND OXYTOCICS. 123 

SPIRITUS AETHERIS NITROSI. 

Incompatibles — Potassium iodide, ferric sulphate, ami- 
pyrin, acacia, tincture of guaiac, tannic and gallic acids. 

Action. It is a diffusible stimulant, stomachic, car- 
minative and nerve sedative. It is diuretic or diapho- 
retic, according to the manner of administration. If 
the patient is kept cool, the diuretic action will be 
dominant. Given with warm water, the patient being- 
well covered, it will produce diaphoresis. 

Administration. As an antipyretic or diaphoretic give 
twenty to thirty minims every half hour. For diuresis, 
one-half to one drachm, with some other diuretic. 
Care should be taken that a reliable preparation is used. 

Therapeutics. Febrile affections, nephritis, con- 
gested kidneys, painful affections of the urinary tract, 
flatulent dyspepsia, nausea, nervous agitation, dys- 
menorrhea. Locally in neuralgic headache. 

LIQUOR AMMONII ACETATIS. (Spirit of Mindererus.) 
Incompatibles — Metallic sulphates, salts of lead and silver, 
lime water, carbonates of potassium and sodium, acids. 

Action. Stimulant to circulation, diuretic or diapho- 
retic, according to the manner of administration, like 
sweet spirits of nitre. 

Administration. The preparation should be freshly 
made and w r ell diluted with sweetened water. 

Therapeutics. Febrile conditions as acute coryza, 
influenza, etc. Muscular rheumatism, eruptive fevers, 
scarlatinous dropsy, migraine, acute alcoholism, dys- 
menorrhea. Locally in glandular swellings, contu- 
sions, incipient abscesses, etc. 



EMMENAGOGUES AND OXYTOCICS. 
Direct. Ergot, digitalis, sabina, ruta, quinine, asafe- 
tida, guaiacum, borax, cantharides. 

Indirect. Hematics, strychnine, cinnamon, aloes. 



124 NOTES ON MATERIA MEDICA. 

SABINA. 

1. External Action. On the skin the drug is an irri- 
tant, and may produce vesication like turpentine. 

Antagonists — Emollients. Synergists — Irritants. 

2. Internal Action. — Digestive Tract. It is irritant 
to the stomach. 

3. Circulation. The heart is stimulated, and the cir- 
culation is increased, especially that of the genital 
organs, which renders the drug emmenagogue, and in 
very large doses abortifacient. 

Antagonist — Viburnum. Synergists — Ergot, quinine, etc. 

4. Absorption and Elimination. It is eliminated by 
the skin, kidneys, lungs and bronchi, stimulating their 
secretions. 

Untoward Action. Large doses cause gastro- 
enteritis, suppression of urine and unconsciousness. 

RUTA. (Rue.) 
In its action and uses like sabina. 



UTERINE DEPRESSANTS. 

VIRBURNUM PRUNIFOLIUM. 

Incompatibles — Like tannic acid. 
This drug is astringent and antispasmodic. 
Nervous System. On the nervous system it has no 
effect on sensibility or consciousness. It is depressant 
to motor centers, lowering reflexes, and it may produce 
paresis or paralysis. 

Antagonists — Strychnine, caffeine, etc. Synergists — Chlo- 
ral, physostigma, etc. 

Circulation. It is reduced by depression of the heart 
muscle and vasomotor center. 

Antagonists — Cardiac stimulants. Synergists — Cardiac 
depressants, 



VESICANTS AND PUSTULANTS. 125 

Uterus. Spasms of the uterus are reduced, and the 
drug is an antiabortifacient. 

Therapeutics. Spasmodic and membranous dysmen- 
orrhea, menorrhagia of the menopause, prevention of 
abortion, after pains. 



RUBEFACIENTS. 
Ammonia, alcohol, camphor, capsicum, chloroform, 
ether, iodine, menthol, mustard, oil of cajuput, oil of 
turpentine, volatile oils. 



VESICANTS AND PUSTULANTS. 

Vesicants. Glacial acetic acid, ammonia, canthari- 
des, iodine, mustard. 

Pustulants. Croton oil, tartar emetic, silver nitrate, 
ipecac. 

CANTHARIDES. 

1. External Action. The drug may be absorbed from 
the skin, and is a rubefacient, and a slow, but powerful 
vesicant. It produces reflex stimulation of the blood 
vessels of underlying organs. 

2. Internal Action. In the stomach it is irritant, and 
may cause gastro-enteritis. 

3. Circulation. Moderate doses stimulate, increasing 
the force and rate of the heart and raising arterial 
tension. Large doses depress. In moderate doses, by 
increasing the blood supply to the genital organs, it is 
emmenagogue. 

4. Nervous System. Moderate doses produce no 
effect. Excessive doses may cause convulsions and 
coma. 

5. Absorption and Elimination. The drug is rapidly 
absorbed, and is eliminated by the kidneys, stimu- 
lating its cells, and at first increasing the urine. It is 



126 NOTES ON MATERIA MEDICA. 

very apt to cause inflammation of the kidney and 
urinary tract. The increased circulation and irritation 
of the genitourinary tract render the drug aphrodisiac. 

Poisoning. Symptoms. Toxic doses may produce 
abortion, and cause gastro-enteritis, strangury, priap- 
ism, hematuria, and swollen genitals. 

Treatment. Demulcent drinks, stimulants, opium. 
Avoid fats and oils, as they dissolve the active prin- 
ciple of the drug. 

Administration. For vesication the drug requires 
from six to eight hours' application. After formation 
of the blister the epidermis should be clipped away, 
and surgical dressings applied to the raw surface. The 
drug is rarely used internally, and when so used the 
tincture is the best preparation. 

Therapeutics. Pneumonia, pleurisy and other deep- 
seated inflammations, boils, pericarditis, neuralgia, sci- 
atica, subacute and chronic meningitis, synovitis, peri- 
ostitis, ovaritis, otitis media, alopecia (i) ; incontinence 
of the urine, pyelitis, catarrh of the bladder, diabetes 
insipidus, gleet, prostatorrhea, spermatorrhea, impo- 
tence (5). 

Contra Indications. Acute inflammation of the gas- 
trointestinal and genito-urinary tracts. 

SINAPIS. 

External Action. Irritant, rubefacient, vesicant. 
Any degree of irritation from redness to blistering. 
More rapid in action than cantharides. It produces 
warmth, burning pain, then loss of sensation. The 
irritation of cutaneous nerve terminals reflexly stimu- 
lates the heart and respiration. 

Internal Action. In small amount it is a powerful 
stimulant to the gastro-intestinal tract. Large doses 
irritate and cause emesis without depression. 



ASTRINGENTS. 127 

Administration. A plaster made of equal parts of 
flour and mustard mixed with water to the consistency 
of a thick paste, spread on cloth and covered with 
dampened gauze. A milder application is prepared by 
making- a corn-meal or flax-seed poultice, to which a 
small quantity of mustard (say, one-sixteenth part) is 
added. As an emetic, one to three drachms in a pint of 
warm water. 

Therapeutics. For counter-irritation, to stimulate 
circulation and respiration in syncope and coma, as a 
bath (one drachm in one gallon of water) in colds, 
measles, scarlet fever, as a Sitz bath in suppressed 
menses. 



CAUSTICS. 
Arsenious acid, carbolic acid, liquor potassae, liquor 
sodae, glacial acetic acid, mineral acids, burnt alum, 
copper sulphate, mercuric chloride, nitrate, and oxide, 
silver nitrate, zinc chloride and sulphate. 



ASTRINGENTS. 

Vegetable. Tannic and gallic acids, catechu, kino, 
krameria, hematoxylon, witch hazel. 

Mineral. Lead, zinc, copper, silver, alum, bismuth, 
cerium oxalate. 

ACIDUM TANNICUM. 

Incompatibles — Salts of iron, lead, silver, antimony and 
copper, alkaloids, glucosides, gelatine, alkalies, mineral 
acids, emulsions. 
I. External Action. It has no effect on the unbroken 
skin. On the broken skin or on mucous membranes it 
is a powerful astringent, contracting tissues and coagu- 
lating albumin. 

Antagonists — Irritants. 



128 NOTES ON MATERIA MEDICA. 

2. Internal Action. — Digestive Tract. It puckers 
and dries the mouth (coagulation of albumin), and 
diminishes the sense of taste. Large doses may cause 
vomiting. In the stomach pepsin is precipitated, albu- 
min is coagulated, and the gastric secretion is lessened. 
In the intestines the drug is partially converted into 
gallic acid, and is thus absorbed, exerting its astringent 
action, lessening peristalsis, and tending to constipate. 

Antagonists — Strychnine, bitters, cathartics. Synergists — 
Opium, belladonna, etc. 

3. Circulation. By its astringent power it is hemo- 
static, contracting blood vessels. Absorbed into the 
blood as gallic acid, and does not act on the blood. 

4. Absorption and Elimination. It is absorbed as 
gallic acid, and is thus eliminated by the kidneys. 

Untoward Action. Pain in the stomach and intes- 
tines, coated tongue, eructations, thirst, hemorrhoidal 
congestion, tenesmus. 

Therapeutics. Bed sores, ulcers, sore nipples, nu- 
merous skin diseases, hyperidrosis, erysipelas, certain 
diseases of the ear, nose and throat, ulcerous gums, 
stomatitis, whooping-cough, hemorrhoids, rectal ulcer, 
fissure and prolapse, leucorrhea, inflammation of the 
cervix, cancer of the uterus, gonorrhea, hemoptysis, 
acute dysentery (by enema) (1) ; intestinal hemor- 
rhage, diarrhea (2) ; alkaloidal poisons. 

Administration. Locally in any form. Internally 
for intestinal effects in pills. For hematemesis in 
powders. Avoid use with iron. 

GALLIC ACID. 

Incompatiblcs — Spirit of nitrons ether and like tannic acid. 
It is like tanic acid, except that it does not coagulate 
albumin, and is far more readily absorbed. 

Therapeutics. It is not so good as tannic acid for 
local effects, but is better for general effects after 



ASTRINGENTS. 



129 



absorption. Hemorrhage of any of the internal organs, 
excessive sweating, bronchorrhea, cystitis, dysentery 
and chronic diarrhea, pyelitis. 

Administration. It is given as either pill or powder. 
Avoid use with iron. 

CATECHU. 

Physiological Action. Like tannic acid, and is more 
energetic than kino. 

Therapeutics. Like tannic acid. 

Administration. Give the troches in pharyngitis, the 
compound tincture in diarrhea. 

KINO. 

Physiological Action. Like tannic acid. 

Therapeutics. Like tannic acid, it acts quickly, and 
is less irritant than tannic acid. 

Administration. Use the powder locally, the tincture 
internally. 

KRAMERIA. 

Physiological Action. Like tannic acid. 

Therapeutics. Like tannic acid, and is often used 
in tooth powders. 

Administration. The powder is given by insuffla- 
tion, for fissure of the anus the aqueous solution of the 
extract. 

HAMAMELIS. 

Physiological Action. Like tannic acid. 

Therapeutics. Like tannic acid. 

Administration. The distilled extract is the best 
preparation. 

HAEMATOXYLON. 

Physiological Action. Like tannic acid. 

Therapeutics. Like tannic acid. It renders the 
stools and the urine red. 

Administration. The decoction is the best prepara- 
tion. 



130 NOTES ON MATERIA MEDICA. 

i 

ALUMEN. 
Incompatibles— Alkalies and their carbonates, salts of 
iron, lead and mercury, tartrates and tannic acid. 

1. External Action. On the unbroken skin it 
thickens and hardens it. On the denuded skin or mu- 
cous membranes it coagulates the albumin and con- 
tracts the small blood vessels. 

Antagonists — Irritants. 

2. Internal Action.— Digestive Tract. It first stimu- 
lates the salivary flow, and then diminishes it by its 
astringent effect, blanching and puckering the tongue, 
and it may injure the enamel of the teeth. It dimin- 
ishes the amount of gastric juice, and precipitates 
pepsin. Excessive dose may cause vomiting, purga- 
tion and pain. 

Antagonists — Bitters, strychnine, cathartics. Synergists — 
Opium, belladonna, etc. 

3. Circulation. It is absorbed by the blood vessels, 
contracting them, hence it lessens all secretions and 
checks hemorrhage. 

Antagonists — Mercury, etc. Synergists — Opium, bella- 
donna, etc. 

4. Elimination. It is eliminated by the kidneys and 
liver. 

Therapeutics. Exuberant granulations, epistaxis, 
superficial bleeding, sore throat, tonsillitis, ulcerous 
stomatitis, swollen gums, salivation, conjunctivitis, 
trachoma, with milk for "black eye," gonorrhea, leucor- 
rhea, gleet, pruritus, hyperidrosis, ingrowing toe nail, 
ulcers, as a spray in bronchorrhea, chronic laryngitis, 
bronchitis, whooping-cough (1) ; internal hemorrhage, 
polyuria (3) ; diarrhea, chronic dysentery, atonic con- 
stipation, lead colic (2). 

Administration. As an emetic, one to two drachms 
in syrup followed by warm water. Internally it is 



ASTRINGENTS. 131 

given in solution in syrup. Externally, dried alum, 
powdered alum or the aqueous solution is used. 

BISMUTH. 

1. External Action. On the unbroken skin it is 
simply proteetive. On the broken skin or mucous 
membranes it is mildly astringent and antiseptic. 

2. Internal Action. — Digestive Tract. It coats the 
mucous membranes, acting as a sedative and mild 
astringent, tongue and stools are darkened, and it tends 
to produce constipation. It is very slowly absorbed. 

Antagonists — Cathartics, irritants. 

3. Nervous System. It is mildly sedative to peri- 
pheral nerve endings. 

4. Elimination. By the urine, bile and feces. 
Untoward Action. Nausea, vomiting, pain, diarrhea, 

constipation, headache and dizziness. 

Poisoning. Symptoms. Like lead. Also sloughs in 
the mouth and digestive tract, albuminous urine, des- 
quamative nephritis. 

Treatment. Lavage, demulcent drinks, freshly pre- 
pared precipitated hydrated oxide of iron. 

Therapeutics. Various skin diseases, ulcers, chapped 
nipples, chapped hands, anal fissure and prolapse, 
burns, gonorrhea, leucorrhea, ozena, stomatitis, saliva- 
tion, fetid sweating, chancres, chronic conjunctivitis 
(1) ; irritable vomiting, diarrhea, gastric ulcer, chronic 
dysentery, cholera infantum, alcoholic gastritis (2). 

Administration. It is used externally as powder or 
ointment, internally in powder, capsules or mixtures. 
CERIUM OXALATE. 

Its action is not understood, but it resembles bismuth 
in its action. 

Therapeutics. Vomiting, cough of phthisis, cough 
of bronchitis, chorea, diarrhea. 

Administration. In pill or powder. 



132 NOTES ON MATERIA MEDICA. 

ARGENTUM NITRAS. 

Incompatibles — The alkalies and their carbonates, chlo- 
rides, hydrochloric and tannic acids, potassium iodide, solu- 
tion of arsenic, organic acids. 

1. External Action. Caustic, coagulates albumin, 
limiting the effect, eschar, at first white, but turns dark 
in the light, hemostatic, irritant to mucous membranes. 

2. Internal Action. — Digestive Tract. It is changed 
in the stomach into peptonates and albuminates. It 
stimulates the intestinal glands and the flow of bile. 
Large doses impair digestion, astringent. 

3. Circulation. Small doses stimulate the heart. It 
lessens the fibrin of the blood, and changes the hemo- 
globin into hematin, and also alters the shape of the red 
blood cells. Large doses depress the heart. (Compare 
mercury.) 

4. Nervous System. It is tonic in small doses. 
Large, doses cause convulsions and paralysis. 

5. Respiration. Small doses are stimulant, large 
doses paralyze the respiratory center. 

6. Absorption and Elimination. It is absorbed from 
the stomach, and is slowly eliminated by the feces, and 
slightly by the kidneys. 

Untoward Action. Long continued use discolors the. 
skin, palpitation and irregular pulse. 

Poisoning.— Acute. Symptoms. Violent gastro- 
enteritis, blackish vomiting resembling milk curds, con- 
vulsions, delirium, eccentric paralysis, profuse bron- 
chial secretions. Death by respiratory paralysis. 

Treatment. Table salt, large quantity of water, soap 
and water or milk, opium. 

Poisoning. — Argyria. Slate-colored discoloration of 
the skin, beginning in the sclerotic conjunctiva, dark 
line on the inner side of the lips, ulcerative stomatitis. 



ASTRINGENTS. I33 

Treatment. Potassium iodide, sodium hyposulphite, 
baths of hyposulphites, or potassium cyanide. The 
discoloration is usually permanent. 

Therapeutics. Ophthalmia, conjunctivitis, felons, 
boils, bed sores, subacute gonorrhea and leucorrhea, 
pruritus, indolent ulcers, chancroids, small-pox erup- 
tion, orchitis and epydidimis, inflammations and ulcera- 
tions of the pharynx, etc., tonsillitis, sore nipples, 
wounds and certain ear diseases (1) ; intestinal and 
gastric ulcer, chronic gastritis, dysentery, diarrhea (2) ; 
locomotor ataxia, epilepsy, chorea (3, 4). 

Administration. For constitutional effects give in 
pill form during active digestion ; for local action on 
the digestive tract give pill on an empty stomach. Dis- 
continue -the administration for a time after two or 
three weeks to prevent chronic poisoning. 
ARGONIN. 

A soluble compound of silver and casein. It is a 
powerful germicide. Even in strong solution it is non- 
irritating, and is without astringent effects. 

Therapeutics. Gonorrhea. 

PLUMBUM. 

1. External Action. It has little action on the un- 
broken skin. On the denuded skin it contracts the 
blood vessels, coagulates the albumin and forms a 
protective coating. It is sedative to nerve terminals, 
and is hemostatic. 

Antagonists — Irritants. Synergists — Astringents, opium, 
etc. 

2. Internal Action. — Digestive Tract. It contracts 
the cells, vessels and mucous membrane of the entire 
alimentary tract, diminishing secretions and peristalsis, 
and hence tending to constipate. Excessive dose may 
act as an irritant poison. 

Antagonists — Mercury, cathartics. 



134 NOTES ON MATERIA MEDICA. 

3. Circulation. It is absorbed as albuminate, and 
interferes with the nutrition of the red blood corpus- 
cles, producing a watery condition of the blood. By 
irritation of the cardiac inhibitory center it slows the 
heart's action. The volume of the pulse is lessened. 

Antagonists — Iron, arsenic, etc. Synergists — Mercury, 
etc. 

4. Nervous System. Excessive doses may cause irri- 
tation of the spine, both motor and sensory, resulting 
in paralysis, especially of the involuntary muscles. 

5. Uterus. It may cause abortion or still birth by 
the changes it produces on the blood. 

6. Absorption and Elimination. It is converted in 
the stomach into the albuminate, and is so absorbed. 
In the intestines it is converted into insoluble sulphide. 
It is directly absorbed from the abraded skin. Elimi- 
nation is by the bile, sweat, milk and urine. It is 
deposited in the tissues. 

Untoward Action. Loss of appetite, gastric pain, 
constipation, colic, external use may cause discolora- 
tion of the skin. 

Poisoning. — Acute (rare). Symptoms. Sweet me- 
tallic taste, nausea and vomiting of a white, curdy 
fluid, constipation, diarrhea with black stools, severe, 
continued abdominal pain, rigid abdominal muscles 
with retraction, great thirst, cramp in the calves of the 
legs, neuralgia pains, twitching, vertigo, stupor, anes- 
thesia, paralysis. 

Treatment. Empty stomach, epsom salts, opium, 
external heat. 

Poisoning.- — Chronic. Symptoms. Any of the above 
w T ith wrist drop and paralysis of extensor muscles, 
colic, small liver, anorexia, coated tongue, blue line on 
gums, discolored mucous membranes, albuminuria, cir- 
rhosis of kidneys, neuritis, atrophy of. _ nerve trunks, 
muscular wasting. 



ANTISEPTICS. 135 

Treatment. Sulphates, cholagogue purgatives, mor- 
phine, sulphuric acid lemonade, milk, potassium iodide, 
diaphoretics, strychnine, electricity. 

Administration. Sub-acetate is not used on abraded 
surfaces. Watery solution of the acetate (two to ten 
grains to one ounce) for local application usually with 
opium or morphine. Lead acetate (three grains) with 
opium (one grain) in pills internally, every three to 
four hours. By enema in strength five grains to one 
ounce of water. Lead nitrate as a powder locally. 

Therapeutics. Acute inflammatory conditions of the 
skin, bruises, gonorrhea, leucorrhea, gleet, hemor- 
rhoids, orchitis, synovitis (1), internal hemorrhages, 
hemoptysis (2, 3), diarrheas, cholera infantum, chronic 
gastritis with pain (2), night sweats (6). 

Lead Subacetate. Bruises, sprains, inflammations, 
itching, felons. 

Lead Iodide. Little used. Enlarged glands, psori- 
asis, eczema. 

Lead Oxide. Sweating feet. 

Lead Nitrate. Onychia, fissured nipples, gangrenous 
sores, fetid discharges. 



ANTISEPTICS. 



Carbolic acid, creosote, guaiacol, salicylic acid, salol, 
salicin, resorcin, ichthyol, iodoform, benzoin and ben- 
zoic acid, balsam of peru, boric acid, borax, potassium 
permanganate, potassium chlorate, sodium hyposul- 
phite, eucalyptus, oil of gaultheria. 

CARBOLIC ACID. 

Incompatibles — Bromine, metallic salts, antipyrin, collo- 
dion, alkalies, lime, soluble sulphates. 

I. External Action. Undiluted it is caustic, produc- 



136 NOTES ON MATERIA MEDICA. 

ing a white scar, which soon turns brown. It coagu- 
lates the albumin, and is therefore limited in its action. 
In weak solutions it causes tingling and reddening of 
the skin. It may be absorbed from the skin. It is dis- 
infectant and antiseptic, and also paralyzes sensory 
nerve terminals, producing anesthetic effect. 

2. Internal Action. — Digestive Tract. In the stom- 
ach, in small doses, it is sedative ; in large doses it is a 
powerful gastric irritant. It is converted in the stom- 
ach into sulpho-carbonates, and is so absorbed. Anti- 
septic. 

Antagonists — Irritants. Synergists — Hydrocyanic acid, 
etc. 

3. Circulation. Small doses have no effect. Large 
doses first slow and then accelerate the heart action. 
Poisonous doses depress and paralyze the heart and 
vasomotor center. 

Antagonists — Atropine, alcohol, opium. 

4. Nervous System. Small doses have no effect. 
Large doses depress the cerebrum (vertigo, stupor) ; 
the anterior cornua are first stimulated (trembling and 
convulsions) ; later depression, then abolition of re- 
flexes. 

Antagonists — Caffeine, strychnine, coca. 

5. Respiration. Large doses first stimulate the vagi 
and the respiratory center, but later depress and par- 
alyze. 

Antagonists — Atropine, strychnine. 

6. Temperature. Large doses lower the temperature 
in fever (lessened heat production and increased heat 
elimination). 

7. Eye. Poisoning doses may cause contracted 
pupils (paralyzing the radiating fibers). 

Untoward Action. Headache, vertigo, rings before 



ANTISEPTICS. 137 

the eyes, muscular weakness, sweating and formica- 
tion. 

8. Absorption and Elimination. The drug is quickly 
absorbed from the gastro-intestinal tract. It is elimi- 
nated by all avenues, chiefly by the kidneys (smoky 
urine, green, suppressed urine) and lungs. 

Poisoning. Is rapid. Symptoms. If not sudden, 
gastro-enteritis, abolished reflexes, shock, albuminous 
or bloody urine. Death by respiratory paralysis. 

Treatment. Wash stomach, epsom salts, external 
heat, atropine, caffeine and opium. 

Administration. Externally may be used in solution 
varying from 1 : 10 to 1 : 500. Internally may be 
given in pills or in capsules or well diluted. 

Therapeutics. Surgery, burns, pruritus, chronic 
eczema and other skin diseases, acute and chronic in- 
flammation of the nose and throat, toothache, chan- 
croids, lupus, gangrene, bites of animals, endometritis, 
ulcers of the cervix (1); fermentative and flatulent 
dyspepsia, dilatation of the stomach, typhoid fever, 
acute and chronic dysentery (2). 

Contra Indications. Acute inflammation of the gas- 
tro-intestinal and genito-urinary tracts. 

THE SULPHO-CARBOLATES. 

These preparations are broken up in the system into 
carbolic acid and sulphates. They then produce the 
combined effect of the acid and base. 

Therapeutics. In relaxed conditions of the throat as 
a gargle, acute bronchitis, nasal catarrh, gonorrhea, 
intestinal antiseptic in diarrhea, fermentative dyspep- 
sia, for this zinc sulpho-carbolate is best. 

Administration. Give sodium sulpho-carbonate in 
solution. Give the zinc salt in pills. 



138 NOTES ON MATERIA MEDICA. 

CREOSOTE, 

Incompatibles — Sulphuric acid and nitric acid, silver salts. 
It is like carbolic acid, except that it does not stimu- 
late the cord so much, and in that it increases the 
coagulability of the blood. It is an efficient stimulant 
expectorant. 

Administration. In capsules or emulsion. By 
gradually increasing the dose tolerance may be estab- 
lished. 

Therapeutics. Locally, like carbolic acid, by inhala- 
tion in phthisis, chronic bronchitis, etc. Internally, 
Phthisis, chronic bronchitis. 

Contra Indications. Like carbolic acid. 

GUAIACOL. 

It is like creosote, but is not so caustic. It may be 
absorbed from the unbroken skin, is antipyretic when 
locally applied to the skin. By its stimulant action on 
mucous membranes it may improve the appetite, but 
large doses may irritate. 

Absorption and Elimination. The drug is rapidly 
absorbed, and. is rapidly eliminated by the kidneys, 
skin, saliva, and to some extent by the lungs. 

Administration and Therapeutics. Like creosote. 

Benzosol (benzoic acid and guaiacol) and guaiacol 
carbonate are like guaiacol in their action. 

SALICYLIC ACID AND THE SALICYLATES. 

Incompatibles — Mineral acids, alkalies, metallic salts. 

1. External Action. It is antiseptic, and also softens 
the epidermis. Locally applied it checks sweating. It 
is irritant to mucous membranes. 

2. Internal Action. Small doses stimulate ; large 
doses irritate. It checks fermentation. 






ANTISEPTICS. 139 

3. Circulation. At first arterial tension and heart 
force are increased by action on the heart muscles and 
vasomotor center. Later it depresses circulation. It 
lessens the migratory movements of the white blood 
cells. 

Antagonists — Cardiac stimulants. Synergists — Cardiac 
depressants. 

4. Nervous System. Large doses may cause cerebral 
congestion (ringing in the ears, fullness, etc.). Re- 
flexes are diminished by depression of the motor mech- 
anism. It has no effect on peripheral nerves. 

Antagonists — Caffeine, strychnine, etc. Synergists — Cere- 
bral depressants. 

5. Respiration. Small doses stimulate the vagi and 
respiratory center ; toxic doses depress and paralyze. 

6. Temperature. Normal temperature is unaffected, 
fever temperature is materially lowered. 

7. Absorption and Elimination. The drug is con- 
verted in the stomach and intestines into sodium sali- 
cylate, and is rapidly absorbed. It is eliminated by the 
kidneys chiefly (greenish urine, urea and uric acid in- 
creased), also by the skin (sweating), but partly by all 
avenues. 

Untoward Action. Rashes, itching, edema, sweat- 
ing, ringing in the ears, motor disturbances, depression. 

Poisoning. Symptoms. Roaring, headache, deaf- 
ness, vertigo, sweating, subnormal temperature, de- 
pressed circulation and respiration, dim vision, ptosis 
and strabismus, involuntary feces and urine. Death 
by respiratory paralysis. 

Treatment. Diffusible cardiac stimulants, diffusible 
respiratory stimulants, external heat, etc. 

Administration. It is best given in solution after 
meals. Give bromides to prevent cerebral effects. 



140 NOTES ON MATERIA MEDICA. 

The salicylates are in every respect like salicylic acid, 
but are not so irritating. 

Therapeutics. Erysipelas, chancroids, various skin 
diseases, acute coryza, stomatitis (i) ; acute articular 
rheumatism (3, 6) ; rheumatic chorea, herpes zoster, 
neuralgic headache, quinsy, lumbago, sciatica (3, 4) ; 
fermentative dyspepsia, flatulence, diarrhea, chronic 
gastric catarrh, chorea (2) ; tape and round worms, 
influenza. 

Contra Indications. Weak heart, debility, acute 
renal inflammation. 

SALOL. 

It is composed of salicylic and carbolic acids. It is 
like salicylic acid, except it is not irritating to the 
stomach, and is more antiseptic, more analgesic and 
more sedative to the brain and cord. 

Administration. Give in pills, capsules or powders. 

Therapeutics. Antiseptic dressing to wounds, ulcers, 
etc. Internally acute and chronic cystitis, gonorrhea, 
intestinal catarrh, catarrhal jaundice, diarrhea, cholera 
morbus, neuritis, myalgia. 

BORIC ACID. 

Incompatiblcs — Carbonates and bi-carbonates, alkaline, 
earthy, and metallic bases. 

i. External Action. It is non-irritating, antiseptic, 
antipruritic and exsiccant. 

2. Internal Action. — Digestive Tract. It retards the 
action of the saliva, but aids gastric and pancreatic 
digestion. Immoderate doses check gastric digestion, 
and may cause gastro-intestinal irritation. 

3. Temperature. It is mildly antipyretic. 

4. Elimination. It is eliminated by the saliva, feces, 
sweat and urine, increasing the quantity of the latter, 






ANTISEPTICS. 141 

and increasing the amount of nitrogenous waste elimi- 
nated. 

Untoward Action. Desire to micturate, nausea, 
vomiting, pain, derangement of the nervous system, 
small, weak pulse, hiccough, cutaneous eruptions. 

Administration. Give in capsules or in solution. 

Therapeutics. Many diseases of the ear, nose, throat 
and mouth, acute conjunctivitis, leucorrhea, gonorrhea, 
chronic cystitis, any condition in which a mild non- 
irritating antiseptic is indicated (1) ; chronic cystitis, 
summer diarrhea (4). 

BORAX. 

i. External Action. It is like boric acid, but is less 
antiseptic, and less antipruritic. It is protective and 
sedative. 

2. Internal Action. — Digestive Tract. It is similar 
to the alkalies, is refrigerant and diuretic ; emmena- 
gogue. 

Therapeutics. It is like boric acid, epilepsy, paralysis 
agitans. 

IODOFORM. 
Incompatiblcs — Mercuric chloride. 

1. External Action. It is non-irritating, checks ser- 
ous oozing from wounds, and is analgesic. 

2. Internal Action. Small doses slightly increase 
the alkaline secretions and the bile. Large doses irri- 
tate the stomach. 

3. Circulation. Small doses strengthen and slow the 
pulse, increasing tension briefly. Full doses lessen 
tension and weaken force. Poisonous doses quicken 
and weaken the pulse, and finally paralyze the cardiac 
muscle. 

4. Nervous System. Large doses may cause head- 
ache, restlessness, stupor, or delirium, reflexes are 
usually lessened, as is the contractility of the muscles. 



142 NOTES ON MATERIA MEDICA. 

5. Absorption and Elimination. It is slowly ab- 
sorbed from the alimentary canal, readily from wounds. 
In the tissues it forms iodides. Elimination is by all 
avenues, but is chiefly by the kidneys as sodium iodate. 
It may accumulate in the system. 

Untoward Action. Skin eruptions, muscular weak- 
ness, double vision, drowsiness, excitement, incohe- 
rence of speech, headache, mental confusion. 

Poisoning. Symptoms. Extensive eruptions, gas- 
tro-enteritis, fixed pupils, intense headache, melan- 
cholia, hallucinations, delirium, mania, dizziness, 
mental confusion, languor, weak, feeble heart, coma, 
paralysis of the sphincters. Poisoning may be prompt 
or may be deferred. 

Treatment. Withdrawal of the drug, stimulants, 
diuretics, diaphoretics, warm bath, opium, potassium 
bicarbonate. 

Administration. It may be given internally in pills 
or in capsules. Externally as powder or ointment. 
Allied compounds substituting the external use of iodo- 
form, equal or superior to it, are : Aristol, europhen, 
iodol, iodosyl. 

Therapeutics. Wounds, ulcers, tuberculous joints, 
hemorrhoids, fistula, anal fissure, diseases of the ear, 
nose and throat, eye and skin, syphilitic lesions. It is 
rarely given internally. 

ICHTHYOL. 
Incompatible •s — Potassium permanganate and other oxi- 
dizing agents. 

i. External Action. It is an antiseptic, parasiticide, 
sedative. It is irritant in full strength, and is readily 
absorbed from the unbroken skin. 

2. Internal Action. — Digestive Tract. It produces 
gastro-intestinal irritation in very large doses. 



ORGANO-THERAPY. 



143 



3. Circulation. It contracts the arteries, and in large 
doses increases the ratio of white blood cells. 

Administration. Externally as ointment or in solu- 
tion in chloroform, alcohol, or ether. Internally in 
capsules. 

Therapeutics. Various skin diseases, synovial in- 
flammations, inflammation of the female genitals, cer- 
tain diseases of the ear and nose. 

OLEUM GAULTHERIiE. 
External Action. It is antiseptic and stimulant. 
Internal Action. It is identical with salicylic acid, 
but is less depressant to the circulation. 

Therapeutics. Like aromatics and salicylic acid. 

METHYL SALICYLATE. 

It is identical in its action with oil of vvintergreen. 
It is synthetically prepared. 



ORGANO-THERAPY. 

The introduction of preparations of animal organs as 
therapeutic agents is so comparatively recent that the 
physiological action is not thoroughly understood, and 
many effects are variously reported by different ob- 
servers. 

THYROID. 

The essential action of this drug is on metabolism, 
increasing the destruction of the proteid substances, 
and therefore causing increased nitrogenous waste in 
the urine, more rapid oxidation of the fats, increased 
diuresis, whether due to the direct action on the kid- 
neys or to the increased excretion of urea is unde- 
termined. This Teads to a rapid loss of weight. The 
effects on the circulation and respiration are uncer- 



144 NOTES ON MATERIA MEDICA. 

tainly determined. There may be no effect, or pulse 
rate may be increased, with a slight fall of arterial ten- 
sion, and respiration may be increased. Excessive 
doses may cause great loss of weight, shortness of 
breath, weak, rapid pulse, general nervousness. 

Administration. A quarter or half of a sheep's gland 
may be eaten raw daily, the glycerin extract may be 
used, best is the dried powdered gland given in doses 
of one grain three times a day, and increased until 
fifteen or twenty grains are taken daily, or until unto- 
ward symptoms arise. 

Therapeutics. Myxedema, obesity, psoriasis, keloid ; 
it may be tried in any case of disturbed nutrition, pro- 
vided there is no tendency to emaciation. 

Contra Indications. Weakened and emaciated con- 
ditions, exophthalmic goitre, diabetes mellitus. 

SUPRA-RENAL CAPSULE. 

It is so rapidly destroyed or eliminated that it has 
but little action when administered by the mouth. 
When administered by intra-venous injection its action 
is prompt. Locally applied (e. g., in the eye) it is a 
powerful constrictor of blood vessels ; its chief action, 
however, is on the circulation, acting much like digi- 
talis. It slows the heart by stimulation of the inhibi- 
tory center, and increases the force by stimulating the 
heart muscle. Arterial tension is tremendously raised 
by stimulation of the muscular coats of the arteries, and 
possibly also of the vasomotor center. It also increases 
pressure in the veins and pulmonary artery. The 
effects are prompt, but are of short duration, the prepa- 
ration being destroyed in the liver or eliminated by the 
kidneys in from fifteen minutes to half an hour. 

Therapeutics. Addison's disease, circulatory failure, 



ORGANO-THERAPY. I45 

conjunctivitis, pannus, keratitis, etc., hay fever, nasal 
congestions, chronic eczema. 

Administration. The aqueous extract is applied 
locally. Tablets of the capsule may be given internally 
in three-grain doses. The glycerin extract is also 
given internally in the dose of from twenty to thirty 
minims. Intra-venous injection is dangerous ; admin- 
istered hypodermically or internally the drug has but 
little effect. 

NUCLEIN. 

This is a natural protection to the body against infec- 
tion. It is provided in the phagocytes and the blood 
serum in the form of proteid-like substances, rich in 
phosphorus. This may be derived also from cell nuclei, 
yeast cells and certain animal tissues. Nuclein in- 
creases the number of leucocytes, especially those of 
the polynuclear variety, which are the most active 
phagocytes. It also increases the germicidal power of 
the blood serum. 

Administration. Preparations which contain no 
phosphorus contain no nuclein. The drug is best given 
on an empty stomach three times a day. Good prepara- 
tions are: Protonuclein, containing 1.25 per cent, of 
phosphorus, given in tablets or powder, in five to ten- 
grain doses. A special powder, containing no sugar of 
milk, is made for local applications. Improved nuclein 
solution (P. D. & Co.), containing 6 per cent, of phos- 
phorus, may be used hypodermically (ten to sixty 
minims), or in drachm doses by mouth. 

Therapeutics. Anemia, tuberculosis, malaria, typhoid, 
septicemia, noma, infectious processes. 

Contra Indications. Gout. 



146 NOTES ON MATERIA MEDICA. 

THE MAMMARY GLAND. 

This drug has been used in sub-involution of the 
uterus, menorrhagia, and other diseases, also to check 
uterine hemorrhage. It checks bleeding, and retards 
the growth of uterine fibroids. Overdoses cause car- 
diac palpitation. 

Administration. It is given in capsules or in tablets, 
five grains three to six times daily. 



SERUM THERAPY. 

The protective power of the blood against bacterial 
infection and its products has been well established. 
This natural protection is provided in two ways, by 
phagocytosis, the destructive power of the white cells 
of the blood for bacteria and other foreign substances, 
and by a theoretical chemical product developed in the 
blood serum, to which the term antitoxin has been 
applied, this antitoxin having the power to counteract 
or render inert the toxic or poisonous products of 
bacterial infection (toxins), which are the cause of the 
systemic disturbances in this class of diseases. 

Experiment has shown that the blood of an animal 
rich in antitoxin can by injection into another animal 
render that animal immune to the infection for a period 
of time, or lessen the virulence of the disease. It has 
also been learned that certain animals are more sus- 
ceptible, and others less susceptible to certain infec- 
tious diseases, or, in other words, that while certain 
animals will promptly succumb to an infection, lacking 
power to produce antitoxin sufficient for their pro- 
tection, other animals, possessing this power in great 
degree, are practically immune to the infection unless 
it be simply overwhelming. Upon these observations 
is based the modern treatment of infectious diseases 
by serum or antitoxins. 



SERUM THERAPY. 



147 



Of the various antitoxins that have been offered, 
only the diphtheritic antitoxin has been established. 
It is prepared by inoculating flasks of bouillon with a 
virulent culture of the bacilli, in which the toxins are 
allowed to develop. The bouillon is then filtered 
through porcelain, which removes all the bacteria, but 
lets through the toxins. This toxic bouillon is injected 
into guinea pigs, very susceptible animals, to de- 
termine the virulence of the preparation, from two to 
one hundred millegrams being necessary to cause 
death. A horse is selected for the development of the 
antitoxic serum, as it is naturally immune to the disease 
and can furnish a large amount of serum. Ten times 
the fatal dose of toxin for a guinea pig is then injected 
into the horse's vein, which stimulates the production 
of antitoxin. This dosage is gradually increased until 
several hundred times the original dose can be given 
without ill effect. The serum is then drawn and tested 
for its protective power in guinea pigs. If one-tenth 
cc. of the serum is of sufficient antitoxic strength to 
protect a pig inoculated with ten times the minimum 
fatal dose of toxin, the serum is said to contain one 
unit of antitoxic power. To prevent the necessity of 
using enormous quantities of serum, which would be 
required in this strength for the protection of man, it 
is now prepared so that one cc. will contain 200, 300, 
or even as high as 1750 units. Care must be taken that 
the preparation used is fresh, as these strong prepara- 
tions do not keep well. 

The preparation is to be administered hypodermi- 
cally with perfect asepsis, the skin and syringe being 
thoroughly sterilized. The strength of the preparation 
used will depend upon the virulence of the case. The 
dose is to be reckoned in units, not in cubic centi- 
metres. For a child over two years of age the initial 



148 NOTES ON MATERIA MEDICA. 

dose should be 1500 to 2000 units, to be repeated in 
twenty-four hours if there is no improvement, and a 
third dose after like interval if necessary. For mild 
cases over two years of age or severe cases under two, 
1000 units is the dose. Treatment should be begun just 
as soon as the diagnosis is clinically made, without 
waiting for bacteriological examination. A dose of 500 
units is used as a preventive in those exposed to infec- 
tion. The serum is harmless, and the joint pains and 
rash which sometimes follow its use, especially with 
preparations of great strength, are without danger, and 
soon disappear. 

Antistreptococcic serum has met with some success 
in sepsis, especially in the puerperium and after injury. 
It has also been used with reported good results in 
infectious endocarditis, but it is not yet established as 
is the diphtheritic antitoxin. 

The various other antitoxins may still be considered 
as in the experimental stage. 



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